Mehmet BALKANAY, Adil POLAT, Ulusoy Nilgün BOZBUĞA, Kaan KIRALİ, Mete ALP, Vedat ERENTUĞ, Deniz GÖKSEDEF, Esat AKINCI, Cevat YAKUT, Gökhan İPEK, Mustafa GÜLER

Acil miyokardiyal cerrahi revaskülarizasyon

Amaç: Bu çalışmada, akut koroner sendromunda cerrahi tedavinin etkinlik ve güvenilirliği araştırılmıştır. Materyal ve Metod: Kliniğimizde 1994-2002 yılları arasında acil endikasyonuyla miyokardiyal cerrahi revaskülarizasyon uygulanan 112 hasta incelendi. Doksan hasta (%80.4) erkek, 22 hasta (%19.6) kadın olup, yaşları 58 ± 10 yıl (36-77) idi. Oniki hasta (%10.7) kardiyolojik invaziv girişim sırasında gelişen oklüzyon nedeniyle ani gelişen infarktüs başladıktan sonra ilk 6 saat içinde ameliyata alındı. Koroner revaskülarizasyon girişimi 85 olguda (%75.9) kardiyopulmoner bypass kullanılarak yapıldı. Yetmiş dokuz olguda (%70.5) komplet revaskülarizasyon uygulandı. Altmış olguda (%53.5) sol internal torasik arter kullanıldı. Dokuz hastada (%8) erken dönemde mortalite saptandı. Kırkdört hastada (%39.2) inotrop ihtiyacı, 39 hastada (%34.8) intraaortik balon desteği, 34 hastada (%30.4) perioperatif miyokardiyal infarktüsü, 22 hastada (%19.6) ventriküler aritmi, üç hastada (%2.7) atriyal aritmi gelişti. Beş olguda (%4.9) ameliyattan sonraki ilk yıl içinde anjiyoplasti uygulandı. Sonuç: Acil revaskülarizasyon düşük morbidite ve mortalite ile uygulanabilmekte ve elektif operasyonlara yakın seviyede başarı sağlanabilmektedir. Postoperatif yoğun bakım izleminde daha yüksek oranda inotrop ve mekanik destek ihtiyacına rağmen uzun dönem sonuçlarının iyi olması, hastaların yakın bir takiple acil revaskülarizasyon prosedürlerinden gerekli şekilde faydalanmalarını sağlayacaktır.

Emergency myocardial surgical revascularization

Background: The aim of this study is to evaluate efficacy and safety of surgical myocardial revascularization. Methods: We have analysed the 112 patients who underwent emergent myocardial surgical revascularization between 1994 and 2002. Ninety of the patients (80.4%) were male and 22 (19.6%) were female. The mean age was 58 ± 10 years (36-77). Twelve patients (10.7%) were operated for the acutely evolving occlusion during the cardiologic intervention within the first 6 hours. Eighty patients (75.9%) were operated on with cardiopulmonary bypass. Complete revascularization was performed in 79 (70.5%) patients. Left internal thoracic artery was used in 60 (53.5%) patients. Results: Mortality was 8% with nine patients. In the postoperative follow up, need for inotropic support occurred in 44 (39.2%), intraaortic baloon pump in 39 (34.8%), perioperative myocardial infarction in 34 (30.4%), ventricular arrhythmias in 22 (19.6%), atrial arrhythmias in three (2.7%) patients. Five (4.9%) patients required angioplasty in the following year. Conclusions: Despite the frequent need for the inotropic and the mechanical support during postoperative follow up, the encouraging results show that with meticulous intensive care, patients may benefit from emergency surgery.

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