Koroner Baypas Cerrahisinde İleri Yaş Grubunda Sol İnternal Torasik Arter Kullanımı

Amaç: Koroner baypas cerrahisinde sol internal torasik arter (LİTA) greftinin kullanılması, daha iyi erken ve geç açıklık ve daha iyi sağ kalım ile sonuçlandığı gösterilmiştir. Arteriyel greftleme, periferik arter hastalığı, kronik obstrüktif akciğer hastalığı, diyabet ve böbrek bozukluklarının daha yüksek prevalansı nedeniyle yaşlı hastalarda uygunsuz kabul edilebilir. Bu çalışmada, LİTA kan akımı, 75 yaşın üzerindeki bir grup hastada diğer tüm bileşenlerden bağımsız olarak ölçülmüştür. Diğer yaş grupları ile anlamlı bir fark olup olmadığının belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Mart 2016 ile Kasım 2021 arasında, ardışık 84 hastaya primer koroner arter baypas greftleme uygulandı. Bu çalışma, tek merkezli, prospektif, randomize bir analizdir. Hastalar üç gruba ayrıldı: Grup I: 60≤ yaş, Grup II: 60-75 yaş ve Grup III: ≥75 yaş üstü. Bulgular: Sol internal torasik arter kan akımları üç grupta ölçüldü: Grup I: 83,7±12,4 ml/dk, Grup II: 79,5±13,4 ml/dk ve Grup III: 78,6±10,6 ml/dk (p≤0,76). Ortalama kan akımı erkeklerde 84,6±14,8 ml/dk, kadınlarda 76,8±9,4 ml/dk (p≤0,05), diyabetiklerde 76,4±12,4 ml/dk, olmayanlarda 86.6±12.8 ml/dk (p≤0.05) idi. Aktif olarak spor yapan hastalarda 88,6±14,2 ml/dk, sporla uğraşmayan hastalarda 78,3±11,3 ml/dk (p≤0,05) bulundu. Sonuç: Sonuç olarak, LİTA kan akımı yaştan etkilenmez. Arteriyel greftlerin koroner arter baypas greftlemesinde mükemmel greftler olduğu genel olarak kabul görmektedir. Bu çalışmada yaşlı gruplarda da LİTA kullanımının yararlı olduğu ve yaşlı popülasyonda da daha çok kullanılması gerektiği sonucu çıkmaktadır.

Anahtar Kelimeler:

Koroner bay pas, ileri yaş, greft, greft

Use of left internal thoracic artery in the advanced age group in coronary bypass surgery

Aim: The use of internal thoracic artery graft in coronary bypass surgery has been shown to result in better early and late patency and improved survival. Arterial grafting may be considered inappropriate in elderly patients due to the higher prevalence of peripheral artery disease, chronic obstructive pulmoner disease, diabetes, and renal disorders. In the present study, left internal thoracic artery (LİTA) blood flow was measured independently from all other components in a group of patients above 75 years of age. An analysis was made to determine if there was significant difference between the other age groups. Material and methods: Between March 2016 and November 2021, primary coronary artery bypass was performed in 84 consecutive patients. The present study is a single-center, prospective, randomized analysis. The patients were divided into three groups: Group I: 60≤ years, Group II: 60-75 years, and Group III: above ≥75 years. Results: Left internal thoracic artery blood flows were measured in the three groups as follows: Group I: 83.7±12.4 ml/min, Group II: 79.5±13.4 ml/min, and Group III: 78.6±10.6 ml/min (p≤0.76). Mean blood flow was 84.6±14.8 ml/min in males, 76.8±9.4 ml/min (p≤0.05) in females, 76.4±12.4 ml/min in diabetics, 86.6±12.8 ml/min (p≤0.05) in non-diabetics, 88.6±14.2 ml/min in patients actively engaged in athletic activities, and 78.3±11.3 ml/min (p≤0.05) in patients who are not engaged in athletic activities. Conclusion: LİTA blood flow is not affected by age. It is a common notion that arterial grafts are excellent conduits in coronary artery bypass grafting. This also seems applicable to elderly patients considering isolated LİTA blood flow. Therefore, the researchers of the current study believe that the use of arterial grafting should be increased in elderly patients.

Keywords:

coronary bypass surgery, greft, advanced age,

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