Koroner Arter Baypas Greft Cerrahisi Yapılan Hastalarda Kardiyovasküler Risk Faktörlerinin ve Koroner Ateroskleroz Ciddiyetinin Uzun Dönem Greft Açıklık Oranına Etkisi

Giriş: Koroner arter baypas greft cerrahisi sonrası başarı, greft açıklığı ile doğru orantılıdır. Koroner arter baypas greft operasyonu geçiren hastalarda nativ arterler ve baypas greftlerinde aterosklerotik süreç devam eder. Bu çalışmanın amacı, koroner arter baypas greft cerrahisi öncesinde belirlenen kişiye ait kardiyovasküler risk faktörlerinin ve koroner anjiyografide saptanan ateroskleroz yaygınlığının operasyon sonrası uzun dönemde greft ömrüne etkisini araştırmaktır. Hastalar ve Yöntem: Çalışmaya 1990-2010 yılları arasında izole koroner arter baypas greft cerrahisi uygulanan ve takiplerinde çeşitli nedenlerle koroner anjiyografileri yapılan toplam 974 hasta (738’i erkek, 236’sı kadın, yaş ortalaması 57.9 ± 9.0 yıl) dahil edildi. Hastalara ait kardiyovasküler risk faktörleri saptandı ve operasyon öncesi koroner anjiyografilerdeki koroner arter hastalığının yaygınlığı Gensini skor indeksi hesaplanarak belirlendi. Tüm bunların uzun dönem greft açıklık oranına etkisi analiz edildi.Bulgular: Koroner anjiyografi sonucunda; tüm greftlerde açıklık oranı birinci yılda %52.6, beşinci yılda %64.6, 10. yılda %38.4 olarak bulunmuştur. Açıklık oranları hem erken (birinci yıl) hem de geç dönemlerde (5 ve 10. yıl) arteryel greftlerde, venöz greftlerden daha iyiydi. Kardiyovasküler risk faktörlerinden yaş (beta: 0.006, p= 0.001), sigara (beta: 0.101, p= 0.003) ve aile hikayesi (beta: 0.063, p= 0.03) tüm greftlerin tıkanıklığında bağımsız risk faktörü olarak bulunmuştur. Tıkalı sol internal mammary arter ile diabetes mellitus (beta: 0.03, p= 0.02) ve Gensini skor indeksi (beta: 0.01, p= 0.03); tıkalı safen ven greft ile yaş (beta: 0.05, p= 0.002), sigara (beta: 0.073, p= 0.002), Gensini skor indeksi (beta: 0.001, p= 0.002); tıkalı sağ internal mammary arter grefti ile sigara (beta: 0.047, p= 0.001), aile hikayesi (beta: 0.033, p= 0.013), Gensini skor indeksi (beta: 0.001, p= 0.001) ilişkili bulunmuştur. Sonuç: Geniş ölçekli bir hasta grubunda kısa ve uzun dönem sonuçların araştırıldığı bu çalışmada, greft aterosklerozu kardiyovasküler risk faktörleri, koroner aterosklerozun yaygınlığı, greft tipi ve greft süresi ile ilişkili bulunmuştur. Uzun dönem greft açıklık oranlarını artırmada günümüzde temel hedef, primer ve sekonder kardiyovasküler risk faktörlerinin iyileştirilmeye çalışılması olmalıdır

The Effect of Cardiovascular Risk Factors and Coronary Atherosclerosis Severity on Long Term Graft Patency Rate in Patients Who Underwent Coronary Artery Bypass Graft Surgery

Introduction: The postoperative success of coronary artery bypass grafting depends on graft patency rate. The atherosclerotic process goes on in native arteries and bypass grafts of patients who underwent coronary artery bypass graft surgery. In this study, we aimed to investigate the effect of preoperative cardiovascular risk factors and the extensity of atherosclerosis detected by coronary angiography on long-term graft survival after the operation. Patients and Methods: We included 974 patients (738 males, 236 females, mean age 57.9 ± 9.0 years) who underwent isolated coronary artery bypass graft surgery between the years 1990-2010 and coronary angiography due to various reasons during their follow-ups. The cardiovascular risk factors of the patients were detected and the extensity of coronary artery disease in the pre-operative coronary angiographies was determined by calculating Gensini Score Index. The effect of these results on graft patency was analyzed. Results: As a result of coronary angiography, overall graft patency rates were found to be 52.6%, 64.6%, and 38.4% in the 1st, 5th and 10th years, respectively. Arterial grafts showed better patency rates than venous grafts in both short-term (1st year) and long-term (5th and 10th years). Independent cardiovascular risk factors were age (beta: 0.006, p= 0.001), smoking (beta: 0.101, p= 0.003), and family history (beta: 0.063, p= 0.03) for all occluded grafts. Diabetes mellitus (beta: 0.03, p= 0.02) and Gensini Score Index (beta: 0.01, p= 0.03) were associated with occluded left internal mammary artery graft. Age (beta: 0.05, p= 0.002), smoking (beta: 0.073, p= 0.002), and Gensini Score Index (beta: 0.001, p= 0.002) were associated with occluded saphenous vein graft. Smoking (beta: 0.047, p= 0.001), family history (beta: 0.033, p= 0.013), and Gensini Score Index (beta: 0.001, p= 0.001) were associated with occluded right internal mammary artery graft. Conclusion: According to short and long-term results of a large group of patients, graft atherosclerosis was associated with cardiovascular risk factors, the extensity of coronary atherosclerosis, type and duration of graft. Today, primary and secondary cardiovascular risk factors should be improved to achieve higher longterm graft patency rates

PDF

___

1. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries: case-control study. Lancet 2004;364:937-52. [Crossref]
2. Moise A, Lesperance J, Theroux P. Clinical and angiographic predictors of new total coronary occlusion in coronary artery disease. Analysis of 313 on-operated patients. Am J Cardiol 1984;54:1176-81. [Crossref]
3. Morrow DA, Gersh BJ, Braunwald E. Chronic coronary artery disease. Braunwald‘s Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed. Philadelphia: Elsevier Saunders, 2005:1281-354. [Crossref]
4. Kaya E, Mansuroglu D, Göksedef D, Ömeroğlu SN, Toker ME, Kırali K, et al. Long-term angiographic results of coronary artery bypass surgery with the use of arterial graft combinations. Türk Göğüs Kalp Damar Cer Derg 2005;13:309-13. [Crossref]
5. Gottlieb SO. Asymptomatic or silent myocardial ischemia in angina pectoris: pathophysiology and clinical implications. Cardiol Clin 1991;9:49-61. [Crossref]
6. Gensini GG, Kisko M. Coronary Arteriogaphy. New York: Futura Publishing Co, 1975. [Crossref]
7. Domanski MJ, Borkowf CB, Campeau L, Knatterud GL, White C, Hoogwerf B, et al. Prognostic factors for atherosclerosis progression in saphenous vein grafts: the postcoronary artery bypass graft (post-CABG) trial. J Am Coll Cardiol 2000;36:1877-83. [Crossref]
8. Motwani JG, Topol JG. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition and prevention. Circulation 1998;97:916-31. [Crossref]
9. Van Brussel BL, Voors AA, Ernst JM, Knaepen PJ, Plokker HW. Venous coronary artery bypass surgery: a more than 20-year follow-up study. Eur Heart J 2003;24:927-36. [Crossref]
10. Goldman S, Zadina K, Moritz T, Ovitt T, Sethi G, Copeland JG, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol 2004;44:2149-56. [Crossref]
11. Ulus T, Yıldırır A, Sade LE, Balta Ş, Özin B, Sezgin A, et al. Serum gammaglutamyltransferase activity: a new marker for coronary artery bypass graft disease. Türk Kardiyol Dern Arşivi 2011;39:205-13. [Crossref]
12. Daida H, Yokoi H, Miyano H, Mokuno H, Satoh H, Kottke TE, et al. Relation of saphenous vein graft obstruction to serum cholesterol levels. J Am Coll Cardiol 1995;25:193-7. [Crossref]
13. Raichlen JS, Healy B, Ascuff SC, Pearson TA. Importance of risk factors in the angiographic progression of coronary artery disease. Am J Cardiol 1986;57:66-70. [Crossref]
14. Neitzel GF, Barboriak JJ, Pintar K, Qureshi I. Atherosclerosis in aorotcoronary bypass grafts. Morphologic study and risk factor analysis 6 to 12 years after surgery. Arteriosclerosis 1986;6:594-600. [Crossref]
15. Tatoulis J, Buxton BF, Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg 2004;77:93-101. [Crossref]
16. Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Habib RH. Late results of conventional versus all-arterial revascularization based on internal thoracic and radial artery grafting. Ann Thorac Surg 2009;87:19-26. [Crossref]
17. Loop FD. Internal thoracic artery grafts: biologically beter coronary arteries. N Engl J Med 1996;334:263-5. [Crossref]
18. Amoroso G, Tio RA, Mariani MA, Van Boven AJ, Jessurun GA, Monnink SH, et al. Functional integrity and aging of the left internal thoracic artery after coronary artery bypass surgery. J Thorac Cardiovasc Surg 2000;120:313-8. [Crossref]
19. Gonzales SJM, Castano RM. Coronary artery surgery in diabetic patients. Rev Esp Cardiol 2002;55:1311-22. [Crossref]
20. Wendler O, Hennen B, Markwirth T, Nikoloudakis N, Graeter T, Schäfers HJ. Complete arterial revascularization in the diabetic patient-early postoperative results. Thorac Cardiovasc Surg 2001;49:5-9. [Crossref]
21. Fiore AC, Naunheim KS, Dean P, Kaiser GC, Pennington G, Willman VL, et al. Results of internal thoracic artery graftingover 15 years: single versus double grafts. Ann Thorac Surg 1990;49:202-9. [Crossref]
22. Tatoulis J, Royse AG, Buxton BF, Fuller JA, Skillington PD, Goldblatt JC, et al. The radial artery in coronary surgery: a 5-year experience-clinical and angiographic results. Ann Thorac Surg 2002;73:143-8. [Crossref]
23. Shah PJ, Gordon I, Fuller J, Seevanayagam S, Rosalion A, Tatoulis J, et al. Factors affecting saphenous vein graft patency: clinical and angiographic study in 1402 symptomatic patients operated on between 1977 and 1999. J Thorac Cardiovasc Surg 2003;126:1972-7. [Crossref]
24. Hess CN, Lopes RD, Gibson CM, Hager R, Wojdyla DM, Englum BR, et al. Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV. Circulation 2014;130:1445-51. [Crossref]
25. Barner HB, Standeven JW, Reese J. Twelve-year experience with internal mammary artery for coronary bypass. J Thorac Cardiovasc Surg 1985;90:668-75. [Crossref]
26. Mehta RH, Honeycutt E, Shaw LK, Sketch MH Jr. Clinical characteristics associated with poor long-term survival among patients with diabetes mellitus undergoing saphenous vein graft interventions. Am Heart J 2008;156:728-35. [Crossref]
27. Domanski MJ, Borkowf CB, Campeau L, Knatterud GL, White C, Hoogwerf B, et al. Prognostic factors for atherosclerosis progression in saphenous vein grafts the postcoronary artery bypass graft (post-CABG) trial. J Am Coll Cardiol 2000;36:1877-83. [Crossref]
28. Campos E, Cinderella J, Farhi E. Long-term angiographic follow-up of normal and minimally diseased saphenous vein grafts. J Am Coll Cardiol 1993;21:1175-80. [Crossref]

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