Salih AYDIN, Deniz DEMİR, Mehmet Halit ANDAÇ, Mustafa GÖZ, Cüneyt SELLİ

Atan kalpte minimal invaziv aksillokoroner bypass greftleme: Orta dönem sonuçlar

Amaç: Bu çalışmada atan kalpte tek damar aksillokoroner bypass greftleme yapılan olgulardaki orta dönem sonuçları ve cerrahi deneyimlerimiz değerlendirildi.Çalışma planı: Beş ameliyat standart aksillokoroner bypass yöntemi uygulanarak sol anteriyor mini torakotomi yoluyla yapıldı. Aksillokoroner bypass greftleme ameliyatı; ciddi aterosklerotik çıkan aort, ciddi kronik obstrüktif akciğer hastalığı, ciddi yürüme sorunu ve düşük ejeksiyon fraksiyonunun eşlik ettiği anlamlı koroner arter hastalığı olan hastalara uygulandı.Bulgular: Aksillokoroner bypass greftleme, ameliyat sırası herhangi bir teknik sorunla karşılaşmaksızın hastaların tümünde dikkatlice uygulandı. Ameliyat sonrası ortalama yoğun bakım süresi 22.8±1.0 saat ve ortalama hastanede kalış süresi 7.3±1.0 gün olarak gerçekleşti. Olguların hiçbirinde brakiyal pleksus yaralanması, nörolojik defisit veya yara infeksiyonu görülmedi. Vazopresör ilaç veya intraaortik balon ihtiyacı olmadı. Bir hasta kaybedildi. Ameliyattan sonra greft açık kalma süresi 24.0±9.4 ay ve ortalama iki yıllık sağkalım oranı %60 olarak gerçekleşti.Sonuç: Çalışmanın küçük olmasına rağmen orta dönem greft açıklık oranının düşük olmasından dolayı bu cerrahi tekniğin yüz güldürücü olmadığı kanaatindeyiz.

Minimally invasive axillocoronary bypass grafting on beating heart: Midterm results

Background: The purpose of the study was to evaluate our surgical experience and midterm results with single vessel axillocoronary bypass grafting on beating heart.Methods: Five operations were carried out via left anterior minithoracotomy, making it a typical axillocoronary bypass procedure. The axillocoronary bypass grafting was performed on patients with significant coronary artery disease who exhibited a severely atherosclerotic ascending aorta, severe chronic obstructive pulmonary disease, serious walk (orthopedic) disorder and low cardiac ejection fraction.Results: Axillocoronary bypass grafting was carefully performed and no technical problems were encountered intraoperatively in all patients. The mean postoperative stay in the intensive care unit was 22.75±0.95 hours, and mean hospital stay was 7.3±1.0 days. No cases of brachial plexus injury, neurologic deficit or wound infection occurred. No cases needed vasopressors or intraaortic balloon pump. There was one mortality. Graft patency since surgery was 24.0±9.4 months and the mean two-year survival rate was 60%.Conclusion: Although our series is small, low graft patency results at mid-term make this surgical method look not too promising for use.

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