Suat CANBAZ, SELÇUK ÜNAL, Murat DİKMENGİL, Enver DURAN

Koroner arter bypass operasyonlarında kullanılan arteriyel ve venöz greftlerin intraoperatif akım ölçüm teknikleri ile değerlendirilmesi

Amaç: Çalışmada, koroner arter cerrahisinde kullanılan greftlerin intraoperatif Transit Time Akım Ölçüm (TTFM) Cihazı ile değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Koroner arter bypass greft (CABG) operasyonu uygulanan 59 hasta çalışmaya alındı. Sol internal mammaryan arter (LİMA) ve safen ven greft olarak çıkartılarak koroner bypass anastomozları gerçekleştirildi. Kardiyopulmoner bypasstan çıkıldıktan sonra Transit Time Flow Meter cihazı ile her bir greften geçen akım miktarı mililitre/dakika olarak, akım eğrisi eş zamanlı olarak ve greftin pulsatilite indeksi (PI) ve diyastolik doluş yüzdesi (%DF) otomatik olarak ölçüldü. Bulgular: Hastaların ortalama greft sayısı 3.25±0.8 idi. Toplam 187 greftte Transit Time Flow Ölçümü yapıldı. En yüksek ortalama akım 55.5 ml/dk ile aorta-RCA sistemde saptanırken en düşük ortalama akım ise 37.6 ml/dk ile aorta-diagonal sistemde ölçüldü. İki hastada toplam 2 greftte (%3.38) akımda yetersizlik saptandı. Sonuç: Transit Time Flow Ölçümü (TTFM), cerrahi esnasındaki teknik yetersizliklerin saptanmasında önemli katkıları olan bir yöntemdir. Perioperatif olarak greft yetersizliğinin saptanması ile küçük girişimlerle, genellikle hatanın düzeltilmesi ve yeterli greft akımının sağlanması mümkün olabilmektedir.

The evaluation of arterial and venous grafts with intraoperative flowmeter techniques in coronary artery bypass grafting operations

Objective: The purpose of this study was to evaluate the coronary artery bypass grafts with Transit Time Flowmeter (TTFM). Material and Methods: Fifty-nine patients who were scheduled for coronary artery bypass graft (CABG) surgery were included in the study. Coronary artery bypass anastomoses were performed using the left internal mammary artery (LIMA) and saphenous vein. At the end of the cardiopulmonary bypass, graft flow (ml/min), pulsatility index (PI), flow curve and diastolic filling percentage (DF%) of each graft were assessed with TTFM. Results: Mean graft number of the patients was 3.25±0.8. We assessed the patency of a total of 187 grafts using TTFM. Highest mean flow was 55.5 ml/min in aorta-RCA grafts and lowest mean flow was 37.6 ml/min in aorta-diagonal grafts. Revision was required for two grafts (3.38%) in two patients based on inadequate TTFM findings. Conclusion: Transit time flowmeter is an important technique that provides the detection of technical errors during surgery. With the detection of graft failure intraoperatively, revision of the graft and restoration of blood flow could be performed.

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