Tamer EROĞLU, Nihat AYDIN, Murat KAYNAK, Cihan Hasan BERAT, Nevzat ERDİL, Bektaş BATTALOĞLU, Vedat NİSANOĞLU

Korener cerahisi geçiren hastalarda internal torasik arter ve radial arter T greft kullanımı

Amaç: Koroner arter cerrahisinde radial arterin (RA) proksimalini sol internal torasik artere (LİTA) anastomoz etmek (T greftleme tekniği), sadece arteriyel greftler kullanılarak tam revaskülarizasyon oranını artırmaktadır. Bu çalışmada LİTA ve RA kullanılarak T greftleme yaptığımız olguların perioperatif, erken ve geç dönem sonuçları irdelendi. Çalışma planı: Mart 2003 ile Aralık 2006 tarihleri arasında koroner arter bypass cerrahisi uygulanan 1118 hastanın 354’ünde en az bir RA grefti kullanıldı. Bu olgulardan LİTA ve RA kullanılarak T anastomoz konfigürasyonu yapılan 91 hasta (65 erkek, 26 kadın; ort. yaş 58±10.3; dağılım 31-80) çalışmaya dahil edildi. Olguların dördünde iki taraflı İTA, 44’ünde iki taraflı RA kullanılırken, 67’sinde RA ardışık greft tarzında kullanıldı. Bulgul ar: Ortalama distal anastomoz sayısı 3.7±0.9 idi. Erken dönem 30 günlük mortalite oranı %2.2 idi (n=2). Düşük kalp debisine bağlı iki hastada intraaortik balon pompası, 12 hastada inotropik destek ihtiyacı oldu. On iki hastada medikal tedavi ile düzelen atriyal fibrilasyon gözlendi. Hiçbir hastada RA çıkarılmasına bağlı bir komplikasyon tespit edilmedi. Ameliyat sonrası dönemde semptomatik sekiz hastaya ortalama 20.4±10.8 aylık takibinde (7-33 ay) kontrol anjiyografi yapıldı, LİTA açıklık oranı %100, RA açıklık oranı %84.2 idi. Sonuç: Seçilmiş hastalarda T greftleme tekniği ile LİTA ve RA kullanılarak tam arteriyel revaskülarizasyon düşük mortalite ve morbidite oranları ile güvenle gerçekleştirilebilir.

Usage of internal thoracic artery and radial artery T graft in patients undergoing coronary surgery

Background: Proximal anastomosis of the radial artery (RA) to the side of the left internal thoracic artery (LITA) (T graft technique) leads to increased rates of complete arterial revascularization in coronary artery bypass surgery. In this study, we examined perioperative, early and late results of T anastomosis with LITA and RA. Methods: From March 2003 and November 2006, 1118 patients underwent coronary artery bypass surgery and among them 354 patients had at least one radial arterial graft. We employed LITA-RA composite T grafts in 91 patients (65 males, 26 females; mean age 58±10.3 years; range 31 to 80 years). In 44 patients bilateral RA, in 67 patients sequential RA and in 4 patients bilateral ITA were used. Results: Mean distal anastomosis number was 3.7±0.9 and mortality rates were 2.2% (n=2) within 30 days of surgery. In two patients intraaortic balloon pump and in 12 patients inotropic agents were used for low cardiac output. Atrial fibrillation occurred in 12 patients which improved with medical therapy. No complications were observed related with RA harvesting. Angiography for clinical indications in eight patients postoperatively (mean 20.4±10.8 months; range 7 to 33 months) demonstrated distal anastomotic patency of 100% for ITA and 84.2% for RA grafts. Conclusion: Complete arterial revascularization can be safely achieved with ITA and radial artery T graft with low perioperative morbidity and mortality rates.

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