Diyalize Bağımlı Kronik Böbrek Yetmezlikli Hastalarda On-pump ve Off-pump Koroner Baypas Cerrahisi

Giriş: Kronik böbrek yetersizliği hastalarında uygulanan koroner baypas cerrahisi normal böbrek fonksiyonlu hastalara göre daha yüksek mortalite ve morbiditeye sahiptir. Kronik böbrek yetmezlikli diyalize giren ve kardiyopulmoner baypas ve kardiyopulmoner baypas olmaksızın iki farklı cerrahi teknikle koroner arter bypas greftleme ameliyatı geçiren hastaların sonuçları incelenmiştir. Hastalar ve Yöntem: Koroner baypas cerrahisi yapılan 55 hasta bu çalışmaya dahil edildi. Bu hastalardan 36 (%65.5)’sı erkek ve 19 (%34.5)’u kadındı. Ortalama yaş 61.24 ± 10.1 yıl (34-83). Olguların %30’unda preoperatif fonksiyonel kapasite kötüydü (NYHA ortalaması 2.04 ± 0.81). Hastalardan 32 (%58.2)’sine tam ve 23 (%41.8)’üne eksik revaskülarizasyon uygulandı. Cerrahi yaklaşım olarak 30 hastaya kardiyopulmoner baypas ve 25 hastaya kardiyopulmoner baypas olmadan uygulandı. Bulgular: Hastaların ortalama ekstübasyon süresi 16.43 ± 11.89 saat (5-72), yoğun bakımda ortalama kalış süre 6.63 ± 6.48 gün (2-30) idi. Hastane mortalitesi 15 hasta ile %27.3, peroperatif miyokart infarktüs oranı %20 ve inotrop destek oranı %27.3 olarak bulundu. Cerrahi teknikler arasında mortalite açısından istatistiksel bir farklılık bulunmamakla birlikte (p= 0.476), KPB- grubunda (%32) mortalite KPB+ grubuna (%23.4) göre daha fazla idi. Tam revaskülarizasyon uygulaması kardiyopulmoner baypas grubunda (%86.7), kardiyopulmoner baypas olmayan gruba (%24) göre anlamlı derecede daha fazla idi (p< 0.001). Sonuç: Kronik böbrek yetmezliğinde uygulanacak koroner baypas girişimlerinde hedef komplet revaskülarizasyon olmalıdır. Bu amaçla ve gerekirse intraoperatif hemodiyaliz uygulaması için kardiyopulmoner baypas tekniğinin seçilmesi daha uygun görünmektedir. Preoperatif fonksiyonel kapasite operatif sonuçları etkilediğinden, kalp yetmezliği bulunan veya acil ameliyata alınan hastalarda preoperatif destek tedavisi (intraaortik balon pompası, inotrop destek) mutlaka uygulanmalıdır.

Anahtar Kelimeler:

Böbrek yetersizliği, hemodiyaliz, koroner baypas cerrahisi

On-pump Versus Off-pump Coronary Bypass Surgery on Patients with Hemodialysis-Dependent Chronic Renal Failure

Introduction: Coronary baypas surgery has more mortality and morbidity risks in patients with chronic renal failure than in individuals with normal functional kidneys. Therefore, the selection of the most helpful medical treatment and surgical technique are important for patient survival and surgical success of revascularization. Patients and Methods: Overall, 55 patients with hemodialysis-dependent chronic renal failure and who underwent open heart surgery were retrospectively studied. Of them, 36 (65.5%) were male and 19 (34.5%) were female, and the mean age was 61.2 ± 10.1 years (range, 34-83 years). Preoperative functional capacity was poor in 30% of patients, and 32 patients (58.2%) underwent complete revascularization and 23 patients (41.8%) underwent incomplete revascularization. Results: There was no statistical difference between the two surgical techniques in terms of mortality (p= 0.476), with 32% mortality in off-pump technique and 23.4% in on-pump technique. The complete revascularization procedure performed excess in the on-pump technique. Complete revascularization rates in on-pump technique was 86.7% and those in off-pump technique was 24%, having a significant difference (p< 0.001). Conclusion: Achieving complete revascularization should be the goal of coronary revascularization in patients with chronic renal failure. On-pump technique is important in complete revascularization procedure and intraoperative hemodialysis. Preoperative support treatment (including intraaortic balloon pump and inotropic support) must be used in patients with heart failure and in emergency surgeries because surgical results are affected by the preoperative functional capacity.

Keywords:

Renal insufficiency, renal dialysis, coronary artery baypas,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi