Hakan GERÇEKOĞLU, Tufan ŞENER, Asuman SÜZER, Tansel TÜRKOĞLU, Bige Naz AYDIN, Tamer AKBULUT, Recep ÖZTÜRK, Hüseyin MAÇİKA

Ana koroner damar veya osteal lezyonlu olgularda atan kalpte koroner bypass cerrahisi sonuçlarının değerlendirilmesi

Amaç: Bu çalışmada kardiyopulmoner bypassa girilmeden atan kalpte yapılan koroner bypass cerrahisinin osteal ve/veya ana koroner damar lezyonlu hastalardaki sonuçları değerlendirildi.Çalışma planı: Ocak 2001-Nisan 2004 ayları arasında osteal ve/veya ana koroner damar lezyonu (%50 ve üzeri darlığı olan) nedeniyle atan kalpte koroner bypass cerrahisi yapılan 26 hasta (19 erkek, 7 kadın; ort. yaş 64±4; dağılım 45-68) geriye dönük olarak değerlendirildi. Hastalardan üçünde sol osteal, birinde hem sol hem sağ osteal, 22'sinde sol ana koroner damarda darlık vardı. Hastalar, ameliyat öncesi, ameliyattan sonra 2. ve 24. saatlerdeki kreatin fosfokinaz-MB düzeyleri; ameliyat öncesi ve sonrası ilk saatteki, 1. ve 6. günlerdeki elektrokardiyografik özellikleri; inotropik ve intraaortik balon pompası ihtiyacı; ekstübasyon, yoğun bakım ünitesi ve hastanede kalış süreleri; mortalite, morbidite ve ilk 30 gündeki takip sonuçları açısından değerlendirildi.Bulgular: On iki hastada acil veya öncelikli olarak ameliyat uygulandı. İnfarktüs sonrası anjinası ve düşük kalp debisi ile acil ameliyata alınan bir hastada, düşük kardiyak debi sebebiyle inotropik destek ve intraaortik balon pompası gereği doğdu. Bu hasta şifa ile taburcu edildi. Diğer 25 hastanın ikisinde gelişen atriyal fibrilasyon dışında morbidite görülmedi. Hastalar ortalama 6. günde taburcu edildi. Ameliyat sonrası ilk 30 günlük takiplerde tekrar hastaneye yatış, mortalite ve morbidite saptanmadı.Sonuç: Çalışmamızın bulguları, osteal veya ana koroner damar lezyonu bulunan olgularda atan kalpte koroner cerrahisinin güvenle uygulanabileceğini göstermektedir.

Evaluation of the clinical results of off-pump coronary artery bypass surgery in patients with left main or osteal coronary lesions

Background: We evaluated the results of beating heart coronary artery bypass grafting without cardiopulmonary bypass in patients with left main coronary artery disease or osteal lesions.Methods: Between January 2001 and April 2004, a total of 26 patients (19 males, 7 females: mean age 64±4 years; range 45 to 68 years) with left main coronary artery disease (≥50% stenosis) or osteal lesions underwent off-pump coronary artery bypass grafting. Three patients had left osteal, one patient had both right and left osteal, and 22 patients had left main coronary artery disease. Evaluations included the following: creatine phosphokinase-MB levels before and at 2 and 24 hours after surgery; electrocardiographic features before and after surgery (1st hour, 1st and 6th days); inotropic and intraaortic balloon pump (IABP) requirements; duration of extubation; lengths of intensive care unit and hospital stays, mortality and morbidity, and follow-up data within the first 30 days.Results: Urgent or emergent surgery was performed in 12 patients. Only one patient who underwent emergent operation due to low cardiac output and postinfarction angina needed inotropic support and IABP. This patient was discharged with recovery. No postoperative morbidity was observed in the remaining 25 patients except for two cases with atrial fibrillation. The mean hospital stay was six days. There were no rehospitalization, morbidity or mortality within the first 30 days of follow-up.Conclusions: Our results demonstrate that off-pump coronary artery bypass grafting is a safe procedure in patients with left main coronary artery disease and osteal lesions.

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1) HCA Case Mix Database, HCA Hospital Company, Nashville TN.
2) Scott NA, Knight JL, Bidstrup BP, Wolfenden H, Linacre RN, Maddern GJ. Systematic review of beating heart surgery with the Octopus Tissue Stabilizer. Eur J Cardiothorac Surg 2002;21:804-17.
3) Stamou SC, Corso PJ. Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future. Ann Thorac Surg 2001;71:1056-61.
4) Yokoyama T, Baumgartner FJ, Gheissari A, Capouya ER, Panagiotides GP, Declusin RJ. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg 2000;70:1546-50.
5) Locker C, Shapira I, Paz Y, Kramer A, Gurevitch J, Matsa M, et al. Emergency myocardial revascularization for acute myocardial infarction: survival benefits of avoiding cardiopulmonary bypass. Eur J Cardiothorac Surg 2000;17:234-8.
6) Ricci M, Karamanoukian HL, Abraham R, Von Fricken K, D�Ancona G, Choi S, et al. Stroke in octogenarians undergoing coronary artery surgery with and without cardiopulmonary bypass. Ann Thorac Surg 2000;69:1471-5.
7) Koutlas TC, Elbeery JR, Williams JM, Moran JF, Francalancia NA, Chitwood WR Jr. Myocardial revascularization in the elderly using beating heart coronary artery bypass surgery. Ann Thorac Surg 2000;69:1042-7.
8) Pasini E, Ferrari G, Cremona G, Ferrari M. Revascularization of severe hibernating myocardium in the beating heart: early hemodynamic and metabolic features. Ann Thorac Surg 2001;71:176-9.
9) Mohr R, Moshkovitch Y, Shapira I, Amir G, Hod H, Gurevitch J. Coronary artery bypass without cardiopulmonary bypass for patients with acute myocardial infarction. J Thorac Cardiovasc Surg 1999;118:50-6.
10) Dewey TM, Mack MJ. Myocardial revascularizaiton without cardiopulmonary bypass. In: Cohn LH, Edmunds LH Jr, editors. Cardiac surgery in the adult. New York: McGraw-Hill; 2003. p. 609-25.
11) Dewey TM, Magee MJ, Edgerton JR, Mathison M, Tennison D, Mack MJ. Off-pump bypass grafting is safe in patients with left main coronary disease. Ann Thorac Surg 2001;72:788-91.
12) Hirose H. Off-pump coronary artery bypass grafting for patients with left main disease. Cardiology 2004;101:194-8.