Selma KENAR TİRYAKİOĞLU, Fatih GOKALP, Osman TİRYAKİOGLU, Evren OZCİNAR

Patient Selection Criteria For Off-Pump and On-Pump Coronary Artery Bypass Grafting

Amaç: Bu çalışmada, koroner arter hastalıklarının tedavisinde off-pump ve on-pump cerrahi metodlarının, güvenilirliği, etkinliği ve teknik seçiminin nedenleri karşılaştırılmıştır. Gereç ve Yöntemler: Mart 2003-Ocak 2013 tarihleri arasında izole KABG( Koroner Arter Baypas Greftleme) operasyonu uygulanan ardışık 540 hasta, retrospektif olarak karşılaştırıldı. On-pump metod ile tedavi edilen 270 hasta(Grup 1) ile off-pump metod ile tedavi edilen 270 hasta (Grup 2) karşılaştırıldı. On-pump metod (Grup 1) uygulanan hastaların, 215'i erkek ve 55'i kadındı ve ortalama yaş 56,3±9,3 idi. 27(%10) hastada sol ana koroner arter lezyonu tanısı kondu. Off-pump metod (Grup 2) uygulanan hastaların, 209'u erkek ve 61'i kadındı ve ortalama yaş 57,8±9,8 idi. Bulgular: Koroner arter baypas yapılan damar sayısı grup 1'de 3,1±0,6; grup 2'de ise 2,1±0,7 idi. Bu farklılık anlamlı bulundu (p=0,016). Mekanik ventilatör desteğinde geçen süre grup 2'de daha kısa idi(p=0,0001). Grup 1'de üç ve/veya daha çok hedef damara baypas yapılan hasta sayısı, grup 2'ye göre daha fazla iken; bir ve/veya iki hedef damara baypas yapılan hasta sayısı ise, grup 2'ye göre grup 1'de daha azdı. CK-MB ve troponin I düzeyleri, grup 2'de daha düşüktü. Grup 2'deki hastaların grup 1'dekilere göre daha kısa hastanede kalış süreleri olduğu gözlendi (p=0,0001). Sonuç: Off-pump operasyon tekniği, daha az sayıda hedef damar sayısı olan hastalarda tercih edilirken; On-pump operasyon tekniği ise diabetes mellitus(DM) tanılı, çoklu damar lezyonu olan ve sol ana koroner arter lezyonu tanısı olan hastalarda tercih edildi.

Offpump ve Onpump Koroner Arter Bypass Greftleme için Hasta Seçim Kriterleri

Background: This study compares safety, efficacy, and reasons of selection criteria between off-pump coronary bypass grafting (OPCAB) and conventional on-pump coronary bypass grafting (CCAB) in patients with coronary artery disease. Material and Methods: The study feeds on a retrospective, observational cohort study of data collected from 540 consecutive patients with coronary artery disease undergoing isolated CABG (coronary artery bypass grafting) (270 OPCAB , 270 CCAB) between March 2003 and January 2013. Two hundred and seventy patients who underwent surgery with on-pump method (group 1) were compared to the group of 270 patients who underwent surgery with off-pump method (group 2). Results: The mean number of anastomoses was 3.1±0.6 in group 1 and 2.1±0.7 in group 2; the difference was significant (p=0.016). The duration of mechanical ventilation support time was shorter for patients in group 2 (p=0.0001). The number of patients with three and/or four target vessel coronary artery bypasses in group 1 was substantially higher compared with the patients in group 2, while the number of patients undergoing one and/or two target vessel bypasses was substantially lower. The levels of CK-MB and troponin I were substantially lower in group 2. Group 2 patients demonstrated shorter hospital stay period than group 1 patients (p=0.0001). Conclusion: The off-pump operation technique is preferred for patients with less target vessel anastomoses, while the on-pump operation technique is preferred for the patients with diabetes mellitus, multiple coronary artery lesions, and left main coronary artery (LMCA) lesions.

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