Hakan GERÇEKOĞLU, Vedat ÖZKUL, Tufan ŞENER, Eren KARPUZOĞLU, Tansel TÜRKOĞLU, Naz Bilge AYDIN

Hemodynamic changes during distal anastomosis of coronary arteries in off-pump CABG surgery

Amaç: Bu çalışmada, off pump koroner arter cerrahisinde (OPCAB) distal koroner arter anastomozlarının yapılabilmesi için, kalbin mobilizasyonu ve stabilizasyonu sırasında oluşabilecek hemodinamik değişimlerin değerlendirilmesi amaçlandı. Çalışma planı: Çalışma Mart-Haziran 2002 tarihleri arasında prospektif olarak düzenlendi. Off-pump koroner arter cerrahisi uygulanan 30 hasta (22 erkek, 8 kadın; ort. yaş 69.5±6.3; dağılım 49-81) çalışmaya alındı. Bu hastalarda bazal ortalama sistemik arter basıncı, sağ atriyal basınç, pulmoner kapiller kama basıncı ve kardiyak indeks ölçümleri, EKG’de ST segment değişiklikleri ve spesifik kardiyak enzim analiziyle beraber, aynı parametrelerin anastomozlar sırasında kalbe posizyon verildikten sonra yapılan ölçümleriyle karşılaştırıldı.Bulgular: Kardiyak indeks düşüklüğü tüm bölgelerde istatistiksel olarak anlamlı iken, ortalama sistemik arteriyel basınç sol ön inen ve arka inen koroner arter bölgelerinde anlamlı şekilde düştü. Sirkumfleks ve arka inen koroner arterlerin anastomozunda sağ atriyal basınç ortalama %70 yükseldi, ama pulmoner kapiller kama basıncı sol ön inen koroner arter anastomozunda ortalama %13, sirkumfleks koroner arter anastomozunda %39 arttı. Belirgin ST segment değişikliği ve anlamlı kardiyak enzim artışı olmadı.Sonuç: Off pump koroner arter cerrahisi sırasında, ameliyatın tüm gidişini etkileyebilecek hemodinamik değişiklikler olabilir. Bazı cerrahi teknik ve manevralarla bu tür hemodinamik değişimlerin üstesinden gelinebilir. Bu nedenle kalp cerrahları, OPCAB için hasta seçimi ve ameliyat sırasındaki sorunları gidermeye yönelik cerrahi teknikler konsunda bilgi sahibi olmalıdırlar.

Atan kalpte koroner arter anastomozları sırasındaki hemodinamik değişiklikler

Background: The aim of this study was to assess the hemodynamic changes during off-pump coronary artery bypass graft (OPCAB) surgery following mobilization and stabilizaiton of the heart in different positions for distal coronary artery anastomoses. Methods: The study was designed as a prospective clinical trail in between March-June 2002. Thirty patients (22 males, 8 females; mean age 69.5±6.3; range 49 to 81 years) operated on by OPCAB surgery were included in the study. The measurements of mean baseline systemic arterial pressure, right atrial pressure, pulmonary capillary wedge pressure, and cardiac index were compared with those that recorded during the mobilization and stabilization of the heart together with ST segment changes and cardiac specific enzyme analysis.Results: The cardiac index drop was statistically significant in all territories while the mean systemic arterial pressure dropped in the left anterior descending and the posterior descending artery territories. The right atrial pressure increased 70% while performing the circumflex and the posterior descending artery anastomosis. Pulmonary capillary wedge pressure increased 13% in LAD and 39% in cirtumflex territories. No significant ST segment changes and cardiac specific enzyme rise was observed.Conclusion: Significant hemodynamic changes can be seen during OPCAB surgery that can effect the whole course of the operation. A surgeon experienced in off pump surgery can overcome the problems caused by hemodynamic changes. Patient selection and certain manoveurs during OPCAB are important aspects that surgeons should be familiar with.

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