Saliha AKSUN, Murat AKSUN, Şahin BOZOK, Mert KESTELLİ, Senem GİRGİN, Atilla ŞENCAN, Derya KUYUCU, Ali GÜRBÜZ, Nagihan KARAHAN, İsmail YÜREKLİ

Comparison of intermittent antegrade cardioplegia and antegrade/retrograde continuous cardioplegia in terms of myocardial protection in cardiac surgery

Amaç: Bu çalışmada kardiyak cerrahide miyokardiyal koruma açısındanintermittant antegrad kardiyopleji ile antegrad/retrograd süreklikardiyopleji karşılaştırıldı.Çalışmaplanı: Ekim 2010 - Ocak 2011 tarihleri arasında kliniğimizdekardiyak cerrahi ameliyatı uygulanan 106 hasta çalışmaya alındı.Hastalar, intermittant antegrad kardiyopleji uygulananlar (grup1; 18 kadın, 14 erkek) ve antegrad/retrograd sürekli kardiyoplejiuygulananlar (grup 2; 16 kadın, 58 erkek) olmak üzere iki grubaayrıldı ve ameliyat sonrası elde edilen sonuçlar karşılaştırıldı. İşlemsürecinde troponin-I, kreatin kinaz-miyokard bandı (CK-MB) düzeyleri,kardiyopulmoner baypas (KPB) ve kros klemp süreleri, kardiyoplejitoplam miktarları ve potasyum kullanımı değerlendirildi.Bul gu lar: Bulgularımıza göre, ortalama troponin-I ve CK-MBdeğerleri grup 1de grup 2den daha yüksekti. Ancak bu farklılıkistatistiksel olarak anlamlı değildi. Grup 1de troponin-I ve CK-MBdeğerleri kros-klemp ve KPB süresi ile korele iken, grup 2detroponin-I ve CK-MB değerleri kros-klemp ve KPB süresi ile koreledeğildi.Sonuç: Troponin-I, CK-MB düzeyleri ile KPB ve kros-klempzamanları arasında anterograd/retrograd sürekli kardiyoplejiuygulanan grupta korelasyon bulunmadı. Buna göre, antegrad/retrograd sürekli kardiyopleji ile efektif miyokardiyal korumasağlandığında, troponin-I ve CK-MB değerleri etkilenmedi vemiyokardiyal koruma daha iyiydi. Anterograd/retrograd süreklikardiyopleji daha iyi miyokardiyal koruma sağlasa da anterogradkardiyopleji sırasında aort basıncı istenen düzeylerde tutulabilmesiiçin monitörize edilmeli ve retrograd kardiyopleji sırasında daretrograd kanül doğru yerde tutulmalıdır.Anahtarsözcükler: Kardiyopleji, koroner baypas cerrahi, miyokardiyalyaralanma, miyokardiyal koruma.

Kardiyak cerrahide miyokardiyal koruma açısından intermittant antegrad kardiyopleji ile antegrad/retrograd sürekli kardiyoplejinin karşılaştırılması

Background: This study aims to compare intermittent antegrade cardioplegia and antegrade/retrograde continuous cardioplegia in terms ofmyocardial protection in cardiac surgery.Methods: Hundred six patients who underwent cardiac surgery in ourclinic between October 2010 and January 2011 were included in the study.Patients were divided into two groups as patients who received intermittentantegrade cardioplegia (group 1; 18 females, 14 males) and who receivedantegrade/retrograde continuous cardioplegia (group 2; 16 females,58 males), and postoperative results were compared. Troponin-I, creatinekinase-myocardial band (CK-MB) levels, durations of cardiopulmonarybypass (CPB) and cross-clamping, total amounts of cardioplegia, andpotassium utilization during the process were evaluated.Results: According to our results, mean troponin-I and CK-MB levelswere higher in group 1 than group 2. However, this difference wasnot statistically significant. While troponin-I and CK-MB values werecorrelated to durations of cross-clamping and CPB in group 1, troponin-Iand CK-MB values were not correlated to durations of cross-clampingand CPB in group 2.Conclusion: No correlation was detected between troponin I, CK-MBlevels, and durations of CPB and cross-clamping in the group whichreceived anterograde/retrograde continuous cardioplegia. Therefore,troponin-I and CK-MB levels were not affected and myocardialprotection was better once effective myocardial protection wasobtained by antegrade/retrograde continuous cardioplegia. Althoughantegrade/retrograde continuous cardioplegia provides better myocardialprotection, aortic pressure must be monitored to be kept between desiredlevels during antegrade cardioplegia, and the retrograde cannula must bekept in the appropriate place during retrograde cardioplegia.

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