İlker MATARACI, Alper ERKİN, Mesut ŞİŞMANOĞLU, Kaan KIRALİ, Fuat BÜYÜKBAYRAK, Güçlü ELEVLİ

Complete revascularization with or without cardiopulmonary bypass using arterial grafts: The six-month angiographic results

Amaç: Bu çalışmada, üç damar koroner arter hastalığı bulunan hastalarda off-pump tam arteriyel revaskülarizasyonun herhangi bir güçlük yaşanmadan gerçekleştirilip gerçekleştirilemeyeceği değerlendirildi.Çalışma planı: Bu ileriye dönük ve randomize çalışmaya üç damar koroner arter hastalığı olan toplam 40 hasta dahil edildi (off-pump grubunda 20, on-pump grubunda 20 hasta) ve her iki gruptaki hastalarda arteriyel greftlerle üç sisteme tam arteriyel revaskülarizasyon uygulandı. İki grup ameliyat öncesi özellikler açısından benzerdi. Off-pump grubunda, kalbin lateral ve posteriyor duvarının revaskülarizasyonu için yürütülen manipülasyon sırasında yeterli koroner perfüzyonun sağlanması için ilk olarak sol ön inen koroner arter revaskülarize edildi. Bu gruptaki hiçbir hastada intrakoroner şant kullanılmadı.Bulgular: İki grup ameliyat öncesindeki ve ameliyat sırasındaki risk faktörleri açısından benzerdi. Hasta başına düşen ortalama distal anastomoz sayısı on-pump grubunda daha yüksekti (3.2±0.4’e karşılık 3±0; p=0.042). Off-pump grubunda ameliyat sonrası transfüzyon gereksinimi (4.5±2.1 üniteye karşılık 6.4±1.8 ünite, p=0.018), ekstübasyon zamanı (7.5±2.5 saate karşılık 10.8±1.8 saat, p

Arteriyel greft kullanılarak kardiyopulmoner bypassla ya da kardiyopulmoner bypassız gerçekleştirilen tam revaskülarizasyon: Altı aylık anjiyografik sonuçlar

Background: The aim of this study was to evaluate whether full off-pump arterial revascularization could be performed in patients with three-vessel coronary artery disease without any difficulty.Methods: A total of 40 patients (20 in the off-pump group and 20 in the on-pump group) with three-vessel coronary artery disease were included in this prospective and randomized study, and patients in both groups underwent complete revascularization for the three systems with arterial grafts. Both groups were similar with respect to the preoperative characteristics. In the off-pump group, the left anterior descending artery was revascularized first to provide adequate coronary perfusion during manipulation of the heart for lateral and posterior wall revascularization. Intracoronary shunt was not used in any of these patients.Results: Both groups were similar for pre- and perioperative risk factors. The mean number of distal anastomoses per patient was higher in the on-pump group (3.2±0.4 versus 3±0; p=0.042). Postoperative transfusion requirements (4.5±2.1 units versus 6.4±1.8 units, p=0.018), extubation time (7.5±2.5 hours versus 10.8±1.8 hours, p

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1) Czerny M, Baumer H, Kilo J, Zuckermann A, Grubhofer G, Chevtchik O, et al. Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass. Ann Thorac Surg 2001;71:165-9.
2) Omeroğlu SN, Kirali K, Güler M, Toker ME, Ipek G, Işik O, et al. Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg 2000;70:844-9.
3) Kim KB, Lim C, Lee C, Chae IH, Oh BH, Lee MM, et al. Off-pump coronary artery bypass may decrease the patency of saphenous vein grafts. Ann Thorac Surg 2001;72:S1033-7.
4) Calafiore AM, Teodori G, Di Giammarco G, Vitolla G, Maddestra N, Paloscia L, et al. Multiple arterial conduits without cardiopulmonary bypass: early angiographic results. Ann Thorac Surg 1999;672:450-6.
5) Nishida H, Tomizawa Y, Endo M, Koyanagi H, Kasanuki H. Coronary artery bypass with only in situ bilateral internal thoracic arteries and right gastroepiploic artery. Circulation 2001;104(12 Suppl 1):I76-80.
6) Muneretto C, Bisleri G, Negri A, Manfredi J, Metra M, Nodari S, et al. Offpump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study. Ann Thorac Surg 2003; 76:778-82.
7) Hirose H, Amano A, Takahashi A. On-pump versus offpump coronary artery bypass using quadruple arterial grafts. Asian Cardiovasc Thorac Ann 2002;10:101-6.
8) Akıncı E, Uzun K, Erentuğ V. The comparison of the early and midterm results of the proximal anastomosis techniques in sequential radial artery grafting. Turkish J Thorac Cardiovasc Surg 2004;12:235-40.
9) Kirali K, Koçak T, Güzelmeriç F, Göksedef D, Kayalar N, Yakut C. Off-pump awake coronary revascularization using bilateral internal thoracic arteries. Ann Thorac Surg 2004;78:1598-602.
10) Kirali K. Composite bilateral internal thoracic artery grafts via standard sternotomy for lateral wall revascularization in conscious patients. Heart Surg Forum 2005;8:E473-7.
11) Kırali K. Mini-T sternotomy for awake coronary revascularization with bilateral internal thoracic artery. Interactive Cardiovasc Thorac Surg 2004;3(Suppl 1):64-5.
12) Mansuroğlu D, Sişmanoğlu M, Omeroğlu SN, Kirali K, Ipek G, Yakut C. A simple method to prevent internal thoracic artery tension: a single pericardio thoracic suture technique. J Card Surg 2004;19:264-6.
13) Kırali K, Yakut N, Güler M. Radial artery in coronary bypass surgery: Anatomical landmarks and harvesting technique. Turkish J Thorac Cardiovasc Surg 1999;7:358-61.
14) Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet 2001;358:870-5.
15) Lev-Ran O, Pevni D, Matsa M, Paz Y, Kramer A, Mohr R. Arterial myocardial revascularization with in situ crossover right internal thoracic artery to left anterior descending artery. Ann Thorac Surg 2001;72:798-803.
16) Toker ME, Omeroglu SN, Kirali K, Balkanay M, Yakut C. Using the bilateral internal mammary artery in the left or right coronary artery system: 5-year comparison of operation techniques and angiographic results. Heart Surg Forum 2005;8:E462-7.
17) Kim KB, Cho KR, Chang WI, Lim C, Ham BM, Kim YL. Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass: early result of Y versus in situ grafts. Ann Thorac Surg 2002;74:S1371-6.
18) Cartier R, Leacche M, Couture P. Changing pattern in beating heart operations: use of skeletonized internal thoracic artery. Ann Thorac Surg 2002;74:1548-52.
19) Plomondon ME, Cleveland JC Jr, Ludwig ST, Grunwald GK, Kiefe CI, Grover FL, et al. Off-pump coronary artery bypass is associated with improved risk adjusted outcomes. Ann thorac Surg 2001;72:114-9.
20) Kirali K, Rabus MB, Yakut N, Toker ME, Erdogan HB, Balkanay M, et al. Early- and long-term comparison of the on- and off-pump bypass surgery in patients with left ventricular dysfunction. Heart Surg Forum 2002;5:177-81.
21) Goldstein DJ, Beauford RB, Luk B, Karanam R, Prendergast T, Sardari F, et al. Multivessel off-pump revascularization in patients with severe left ventricular dysfunction. Eur J Cardiothorac Surg 2003;24:72-80.
22) Yeatman M, Caputo M, Narayan P, Ghosh AK, Ascione R, Ryder I, et al. Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations. Ann Thorac Surg 2002;73:1411-7.
23) Puskas JD. Invited commentary. Ann Thorac Surg 2002; 73:1417.
24) Kirali K, Mansuroğlu D, Kayalar N, Güzelmeriç F, Alp M, Yakut C. Markers of myocardial ischemia in the evaluation of the effect of left anterior descending coronary artery lesion and collateral circulation on myocardial injury in 1-vessel off-pump coronary bypass surgery. Heart Surg Forum 2003;63:143-8.