Deniz GÖKSEDEF, Denyan MANSUROĞLU, Kaan KIRALİ, Başar SAREYYÜPOĞLU, Murat Güçlü ELEVLİ, Cevat YAKUT, Gökhan İPEK, Suat Nail ÖMEROĞLU

Atan kalpte tam revaskülarizasyon: Altı aylık anjiyografik sonuçlar

Amaç: Bu çalışmada, atan kalpte tam revaskülarizasyon uygulanan hastaların perioperatif dönem karakteristikleri incelendi, erken morbidite ve mortalite nedenleri ortaya konarak, ameliyatlarda kullanılan greftlere ait kısa dönem anjiyografik sonuçlar belirlendi.Çalışma planı: Aralık 2002-Mayıs 2004 tarihleri arasında kliniğimizde birden fazla hedef damar lezyonu nedeniyle atan kalpte tam revaskülarizasyon ameliyatı uygulanan ve ameliyatları aynı ekip tarafından yapılan toplam 89 hasta (81 erkek, 8 kadın; ort. yaş 59.7±9.2; dağılım 40-79 yıl) çalışmaya dahil edildi. Aynı dönem içerisinde tam revaskülarizasyon yapılmayan hastalar çalışmaya alınmadı. Tüm hastalara intravenöz narkotik anestezi tekniği ile genel anestezi uygulandı. Tüm hastaların hedef damar revaskülarizasyonuna sol ventrikülü besleyen sistemlere öncelik verilerek başlandı. Sol sistemin revaskülarizasyonunu takiben dominant koroner arter sistemine öncelik verildi. Toplam 43 hastaya kontrol anjiyografisi uygulandı.Bulgular: En yüksek açıklık oranı %100 ile sol internal mammaryan arter greftte saptandı. Bilateral internal mammaryan arter greftleri sol ön inen koroner arter için kullanıldığında açıklık oranlarının %100 olduğu saptandı. Radiyal arter için en uygun kullanılacak hedef damar sisteminin sirkumfleks arter sistemi olduğuna karar verildi. Safen ven greftlerinin açıklık oranları arteriyel greftlerin oldukça altında bulundu.Sonuç: Atan kalpte tam revaskülarizasyonun arteriyel greftler ile de başarılı bir şekilde yapılabileceği görüldü.

Off-pump complete revascularization: Angiographic results at six months

Background: In this study, perioperative characteristics of the patients in whom complete off-pump revascularization was performed were investigated, and short term angiographic results concerning the grafts used in the operations were determined by revealing the causes of initial morbidity and mortality.Methods: Between December 2002 and May 2004, 89 patients (81 males, 8 females; mean age 59.7±9.2 years; range 40 to 79 years) who had complete revascularization operation on the beating heart because of multiple vessel lesions and who were operated on by the same operating team were included in our study. Those patients who didn�t have complete revascularization in the same period were not included in the study. General anesthesia was performed in all patients by means of intravenous narcotic anesthesia. In all patients, target vessel revascularization was started by giving priority to the systems supplying the left ventricule. Following revascularization of the left system, dominant coronary artery system was given priority. A total of 43 control angiographies were performed.Results: The best patency rate was 100% and it was observed in left internal mammarian artery. Bilateral internal mammary artery grafts for left anterior descending territory had also 100% patency. The best patency rate for radial artery was observed by using radial artery to circumfleks territory. The patency rates of saphenous vein grafts was lower than any other arterial graft.Conclusion: Complete revascularization using arterial grafts on the beating heart can be performed succesfully.

PDF

___

1) Kırali K, Yakut N, Güler M, Ömeroğlu SN, Mansuroğlu D, Akıncı E, et al. Koroner arter bypass cerrahisinde radial arter: Anatomik komﬂulukları ve çıkarma tekniği. Türk Göğüs Kalp Damar Cer Derg 1999;7:358-61.
2) He GW. Verapamil plus nitroglycerin solution maximally preserves endothelial function of the radial artery: comparison with papaverine solution. J Thorac Cardiovasc Surg 1998;115:1321-7.
3) Mariani MA, Gu YJ, Boonstra PW, Grandjean JG, van Oeveren W, Ebels T. Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate? Ann Thorac Surg 1999;67:1370-5.
4) Pick AW, Orszulak TA, Anderson BJ, Schaff HV. Single versus bilateral internal mammary artery grafts: 10-year outcome analysis. Ann Thorac Surg 1997;64:599-605.
5) Gerola LR, Puig LB, Moreira LF, Cividanes GV, Gemha GP, Souto RC, et al. Right internal thoracic artery through the transverse sinus in myocardial revascularization. Ann Thorac Surg 1996;61:1708-12.
6) Chow MS, Sim E, Orszulak TA, Schaff HV. Patency of internal thoracic artery grafts: comparison of right versus left and importance of vessel grafted. Circulation 1994; 90:II129-32.
7) Bezon E, Karaterki A, Barra JA. Failure of coronary artery bypass with the internal thoracic artery. Does extended use of the internal thoracic artery affect the patency of the coronary artery? Arch Mal Coeur Vaiss 1998;91:1139 44. [Abstract]
8) Dietl CA, Benoit CH, Gilbert CL, Woods EL, Pharr WF, Berkheimer MD, et al. Which is the graft of choice for the right coronary and posterior descending arteries? Comparison of the right internal mammary artery and the right gastroepiploic artery. Circulation 1995;92(9 Suppl):II92-7.
9) Khot UN, Friedman DT, Pettersson G, Smedira NG, Li J, Ellis SG. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts. Circulation 2004;109:2086-91.
10) Hirose H, Amano A, Takahashi A, Takanashi S. Skeletonization of the radial artery with the ultrasonic scalpel: clinical and angiographic results. Heart Surg Forum 2003;6:E42-7.
11) He GW. Invited commentary. Ann Thorac Surg 2004; 77:811.
12) Hirose H, Amano A, Takahashi A. Bypass to the distal right coronary artery using in situ gastroepiploic artery. J Card Surg 2004;19:499-504.
13) Buxton BF, Ruengsakulrach P, Fuller J, Rosalion A, Reid CM, Tatoulis J. The right internal thoracic artery graftbenefits of grafting the left coronary system and native vessels with a high grade stenosis. Eur J Cardiothorac Surg 2000;18:255-61.