Burçin ABUD, Yüksel BEŞİR, Orhan GÖKALP, Cengiz ÖZBEK, Tayfun GÖKTOĞAN, Engin TULUKOĞLU, Ali GÜRBÜZ, Ufuk YETKİN

Hemodiyalize bağımlı son dönem böbrek yetmezlikli hastalarda konvansiyonel koroner arter bypass ile atan kalpte koroner arter bypass cerrahisinin sonuçları

Amaç: Kardiyak sorunların, son dönem böbrek yetmezlikli (SDBY) hastalarda en sık ölüm nedeni olduğu bilinmektedir. Çalışmamızda, hemodiyalize bağımlı SDBY'li koroner arter hastalarında uygulanan konvansiyonel koroner arter bypass cerrahisi (KABC) ve atan kalpte KABC'nin ameliyat sırası ve ameliyat sonrası erken dönem sonuçları karşılaştırıldı.Çalışma planı: Koroner arter hastalığı nedeniyle, hemodiyalize bağımlı SDBY'li 21 hastaya KABC uygulandı. Atan kalpte KABC uygulanan grupta 11 hasta (8 erkek, 3 kadın; ort. yaş 60±11; dağılım 45-76), konvansiyonel yöntemle revaskülarizasyon uygulanan grupta 10 hasta (6 erkek, 4 kadın; ort. yaş 62±10; dağılım 42-74) vardı. Hastaların ameliyat öncesi, ameliyat sırası ve sonrası verileri karşılaştırıldı. Bulgular: İki grup arasında demografik özellikler, ameliyat öncesi risk faktörleri ve laboratuvar bulguları açısından anlamlı fark yoktu (p>0.05). Grup 1 ve 2'de ortalama anastomoz sayısı sırasıyla 1.7±0.7 ve 2.1±0.7 idi (p>0.05). Ameliyat verilerinden sadece ameliyat süresi anlamlı farklılık gösterdi; grup 1'de ameliyat süresi anlamlı derecede kısaydı (175±17 dk ve 277±56 dk; p

The results of conventional coronary artery bypass and beating-heart coronary artery bypass grafting in patients with hemodialysis-dependent end-stage renal failure

Background: Cardiovascular disease remains the most frequent cause of death in patients with end-stage renal disease (ESRD). This study was designed to compare the perioperative and short-term results of conventional coronary artery bypass surgery (CABS) and off-pump CABS in hemodialysis-dependent ESRD patients with coronary artery disease (CAD).Methods: Twenty-one hemodialysis-dependent ESRD patients underwent CABS for CAD. The off-pump group consisted of 11 patients (8 males, 3 females; mean age 60±11 years; range 45 to 76 years), and the on-pump group consisted of 10 patients (6 males, 4 females; mean age 62±10 years; range 42 to 74 years). The two groups were compared with respect to preoperative, perioperative, and postoperative data. Results: The two groups did not differ with respect to demographic characteristics, preoperative risk factors, and laboratory findings (p>0.05). The mean number of anastomoses was 1.7±0.7 in the off-pump group compared to 2.1±0.7 in the on-pump group (p>0.05). The only significant perioperative difference was the operation time, which was shorter in the off-pump group (175±17 min vs 277±56 min; p

PDF

___

1) Ma KW, Greene EL, Raij L. Cardiovascular risk factors in chronic renal failure and hemodialysis populations. Am J Kidney Dis 1992;19:505-13.
2) Comorbid conditions and correlations with mortality risk among 3.399 incident hemodialysis patients. Am J Kidney Dis 1992;20(5 Suppl 2):32-8.
3) Venkatesan J, Henrich WL. Anemia, hypertension, and myocardial dysfunction in end-stage renal disease. Semin Nephrol 1997;17:257-69.
4) Disney AP. Demography and survival of patients receiving treatment for chronic renal failure in Australia and New Zealand: report on dialysis and renal transplantation treatment from the Australia and New Zealand Dialysis and Transplant Registry. Am J Kidney Dis 1995;25:165-75.
5) Ko W, Kreiger KH, Isom OW. Cardiopulmonary bypass procedures in dialysis patients. Ann Thorac Surg 1993;55:677-84.
6) Kaul TK, Fields BL, Reddy MA, Kahn DR. Cardiac operations in patients with end-stage renal disease. Ann Thorac Surg 1994;57:691-6.
7) Hennekens CH. Risk factors for coronary heart disease in women. Cardiol Clin 1998;16:1-8.
8) Sans S, Kesteloot H, Kromhout D. The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J 1997;18:1231-48.
9) Ener S. Koroner cerrahisinde yeni çağ “OPCAB”. Uludağ Üniversitesi deneyimi. In: 6. Ulusal Göğüs Kalp Damar Cerrahisi Kongresi; 21-25 Ekim 2000; Antalya.
10) Hart JC, Spooner TH, Pym J, Flavin TF, Edgerton JR, Mack MJ, et al. A review of 1,582 consecutive octopus off-pump coronary bypass patients. Ann Thorac Surg 2000;70:1017-20.
11) Dewey TM, Mack MJ. Myocardial revascularization without cardiopulmonary bypass. In: Cohn LH, Edmunds LH Jr, editors. Cardiac surgery in the adult. 2nd ed. New York: McGraw-Hill; 2003. p. 609-26.
12) Hernandez F, Cohn WE, Baribeau YR, Tryzelaar JF, Charlesworth DC, Clough RA, et al. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multicenter experience. Ann Thorac Surg 2001; 72:1528-33.
13) van Dijk D, Nierich AP, Jansen EW, Nathoe HM, Suyker WJ, Diephuis JC, et al. Early outcome after off-pump versus onpump coronary bypass surgery: results from a randomized study. Circulation 2001;104:1761-6.
14) Iscan HZ, Kandemir O, Gol MK, Saritas A, Tasdemir O. Coronary reoperations without the use of cardiopulmonary bypass. Cardiovasc Surg 2003;11:155-8.
15) Omeroglu 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.
16) Kazaz H, Ustunsoy H, Celkan MA, Soydinc S, Kayiran C, Bayar E. Midterm results of off-pump coronary artery bypass surgery in 136 patients: an angiographic control study. J Card Surg 2006;21:6-10.
17) Vural KM, Iscan ZH, Kunt A, Sener E, Tasdemir O. Off-pump coronary artery bypass grafting: long term angiographic results. J Card Surg 2005;20:153-9.
18) 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.
19) Durmaz I, Yagdi T, Calkavur T, Mahmudov R, Apaydin AZ, Posacioglu H, et al. Prophylactic dialysis in patients with renal dysfunction undergoing on pump coronary artery bypass surgery. Ann Thorac Surg 2003;75:859-64.
20) Kahn JK, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Hartzler GO. Short- and long-term outcome of percutaneous transluminal coronary angioplasty in chronic dialysis patients. Am Heart J 1990;119:484-9.
21) Herzog CA, Ma JZ, Collins AJ. Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes. Circulation 2002;106:2207-11.
22) Horst M, Mehlhorn U, Hoerstrup SP, Suedkamp M, de Vivie ER. Cardiac surgery in patients with end-stage renal disease: 10-year experience. Ann Thorac Surg 2000;69:96-101.
23) Kan CD, Yang YJ. Coronary artery bypass grafting in patients with dialysis dependent renal failure. Tex Heart Inst J 2004;31:224-30.
24) Dewey TM, Herbert MA, Prince SL, Robbins CL, Worley CM, Magee MJ, et al. Does coronary artery bypass graft surgery improve survival among patients with end-stage renal disease? Ann Thorac Surg 2006;81:591-8.
25) Taşdelen A, Özkan S. Kronik böbrek yetmezlikli hastalarda açık kalp cerrahisi. In: Duran E, editör. Kalp ve damar cerrahisi. Cilt 2. İstanbul: Çapa Tıp Kitabevi; 2004. s. 1481-95.
26) Aşlamacı S, Sezgin A, Taşdelen A, Gültekin B, İkizler C. Kronik böbrek yetersizliği olan hastalarda kalp cerrahisi. Türk Göğüs Kalp Damar Cer Derg 1995;3:253-8.