Aşkın Ender TOPAL, Habib ÇİL, Zuhal ATILGAN, Fırat AYAZ, M. Nesimi EREN, Celal YAVUZ

Changes in left ventricular functions after coronary artery by-pass surgery

Amaç: Bu çalışmada koroner by-pass cerrahisi yapılan hastaların sol ventrikül fonksiyonlarının transtorasik ekokardiografi ile değerlendirilmesi.Yöntemler: Ocak 2008 ile Mart 2009 tarihleri arasında koroner by-pass yapılan 64 hasta geriye dönük olarak incelendi. Hastaların tanısı, yaşı, cinsiyeti, diabetes mellitus ve hipertansiyon tanıları ve sigara kullanımı durumları tespit edildi. Operasyon öncesinde ve sonrasında sol ventrikül fonksiyonlarına bakıldı.Bulgular: Çalışmaya dâhil edilen 64 hastanın 44’ü erkek 20’si kadın idi. Yaş ortalaması 58 ± 6,2 yıl (43–84 yaş) idi. Çalışmaya alınan hastalardan en düşük sol ventrikül ejeksiyon fraksiyonuna sahip 2 hastanın değerleri %30 idi. Hastaların 4’üne dört damar, 34’üne üç damar, 21’ine iki damar, 5’ine ise tek damar koroner by-pass cerrahisi yapıldı. Kanamadan dolayı 4 hasta (%6.2) revizyona alındı. Preoperatif sol ventrikül ejeksiyon fraksiyonu ortalama %48 ± 5,4 iken, altıncı aydaki kontrolde solventrikül ejeksiyon fraksiyonu ortalama %58,7 ± 2,4 idi. Bu fark istatiksel olarak anlamlı bulundu. Operasyonla ilişkili 3 hastada (%4,68) mortalite görüldü.Sonuç: Koroner by-pass yapılan hastalarda postoperatif sol ventrikül fonksiyonlarında anlamlı düzelmeler tespit edildi.

Koroner arter by-pass cerrahisi sonrası sol ventrikül fonksiyonlarındaki değişiklikler

Objectives: The aim of this study was to evaluate the left ventricular functions with transthoracic echocardiography after coronary bypass surgery.Methods: Sixty-four patients who underwent coronary bypass surgery between January 2008 and March 2009 were retrospectively evaluated. The diagnosis, age and gender of the patients, presence of diabetes mellitus and/or hypertension, smoking, and left ventricle functions before and after surgery were recorded.Results: The mean age of the patients was 58 ± 6,2 years. Forty-four of 64 patients were male, and 20 were female. The lowest ejection fraction was measured in two patients as 30% preoperatively. The mean preoperative and postoperative left ventricle ejection fractions were 48 ± 5.4% and 58 ± 2.4% respectively. This difference was found statistically significant. The mortality rate of by-pass surgery was 4.68% (3 patients).Conclusion: The left ventricular functions were significantly recovered after coronary by-pass surgery.

PDF

___

1. Hung J, Kelly DT, Baird DK, et al. Aorta coronary bypass grafting with severe left ventricular dysfunction. J Thorac Cardiovasc Surg 1980;79:718–23.
2. Olsen PS, Kassis E, Jorgensen UN. Coronary artery bypass surgery in patients with severe left ventriculer dysfunction. J Thorac Cardiovasc Surg 1993;41:118–20.
3. Kirklin JW, Barratt-Boyes BG: Stenotic arteriosclerotic coronary artery disease. Cardiac Surgery 2nd Edition. New York: Churchill Livingstone Inc., l993;pp:285–381.
4. Pasquet A, Lauer SM, Williams MJ, et al. Prediction of global left ventricular function after bypass surgery in patients with severe left ventricular dysfunction. Eur Heart J 2000;21:125–36.
5. Kaul S. There may be more to myocardial viability than meets the eye. Circulation 1995;92:2790–3.
6. Lamas GA, Flaker GC, Mitchell G, et al. Effect of infarct artery patency on prognosis after acute miyocardial infarction. The Survival and Ventricular Enlargement Investigators. Circulation 1995;92:1101–9.
7. Raunwald E. Myocardial reperfusion, limitation of infarct size, reduction of left ventricular dysfunction and improved survival. Should the paradigm be expanded? Circulation 1989;79:441–4.
8. Rhimtoola SH. The hybernating myocardium. Am Heart J 1989; 117:211–21.
9. Hausmann H.Tropp H, Siniawski H, Holz S, Hetzer R. Decision-making in end stage coronary artery disease; revascularization or heart transplatation? Ann Thorac Surg 1997;64:1296–301.
10. Al-Mohammed A, Mahy IR, Norton MY, et al. Prevalence of hibernating myocardiumin patients with severely impaired ischaemic left ventricles. Heart 1998;80:559–64.
11. Schwarz ER, Schaper J, Vom Dahl J, et al. Myocyte degeneration and cell death in hibernating human myocardium. J Am Coll Cardiol 1996;27:1577–85.
12. Islamoğlu F, Apaydın AZ, Posacıoğlu H, et al. Coronary artery bypass grefting in patients with poor left ventricular function. Jpn Heart J 2002;43:343–56.
13. Elhendy A, Cornel JH, van Damburg RT, et al. Effect of coronary artery bypass surgery on myocardial perfusion and ejection fraction response to inotropic stimulation in patients without improvement in resting ejection fraction. Am J Cardiol 2000;86:490–4.
14. Bonow RO. Identification of viable myocardium. Circulation 1996;94,2674–80.
15. Spooner TH, James CH, Pym J: A two year, three institution experience with the Medtronic Octopus: Systemic Off-Pump Surgery. Ann Thorac Surg 1999;68:1478–81.
16. Arom KV, Flavin TF, Emery RW, et al. Is low ejction fraction safe for off pump coronary bypass operations? Ann Thorac Surg 2000;70:1021–5.
17. Murkin JM, Martzke JS, Buchan AM, Bentley C, Wong CJ. A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery: 2nd Neurologic and cognitive outcomes. J Thorac Cardiovasc Surg 1995; 110:349–62.
18. Mansuroglu D, Omeroglu SN, Erentug V, et al. Combined off-pump coronary artery bypass surgery and abdomimnal aorta aneurysm repair. J Card Surg 2004; 19:267–9.
19. Grunderman PF, Borst C, Van Herwaanden JA, Verlaan CWJ Jansen EWL. Vertical displacement of the beating heart by the octopus tissue stabilizer: Influence on coronary flow. Ann Thorac Surg 1998;65:1348–52.
20. Akalın H: Aterosklerotik koroner arter hastalığının cerrahi tedavisi. Akalın H, Özyurda Ü. Uçanok K, Çorapçıoğlu T, Uysalel A, Kaya B. Kalp Damar Cerrahisi Ders Kitabı. Ankara Duygu Ofset 1992; pp:81–105.
21. Kirklin JW, Barrat-Boyes BG. Mitral valve disease with or without tricuspit valve disease. Cardiac Surgery 2nd. Edition. New York. Churchill Livingstone lnc., l993;pp:425–89.
22. Puskas ID, Williams WH, Mahoney EM, et al. Off pump vs. conventional coronary artery bypass grafting: Early and 1-year graft patency cost and quality of life outcomes: A randomized trial. JAMA 2004;291:1841–9.