Mehmet BALKANAY, Denyan MANSUROĞLU, Erhan KAYA, Kaan KIRALİ, Mehmet Erdem TOKER, Deniz GÖKSEDEF, Cevat YAKUT, Gökhan İPEK, Suat Nail ÖMEROĞLU

Koroner arter bypass cerrahisinde birden fazla arteryel greft kullanılan hastalarda uzun dönem anjiyografik sonuçların değerlendirilmesi

Amaç: Çalışmamızda birden fazla arteryel greft kullanılarak yapılan koroner bypass ameliyatlarının uzun dönem sonuçları ve greft açıklığını etkileyen faktörler incelendi. Çalışma planı: 1996-2002 yılları arasında 331 hasta (320 erkek, 11 kadın; ort. yaş 46.9±7.3; dağılım 28-69) birden fazla arteryel greft kullanılarak ameliyat edildi. Ameliyatlarda 329 olguda sol internal mammaryan arter (LİMA), 192 olguda radiyal arter (RA), 147 olguda sağ internal mammaryan arter (RİMA) kullanıldı. Olguların 281’inde iki arter birlikte kullanıldı (178 hastada LİMA+RA, 103 hastada LİMA+RİMA). Hastaların 182’sine (%55) tam arteryel revaskülarizasyon uygulandı. Olgular ortalama 45.3±25.5 ay (dağılım 1-113 ay) takip edildi. Greft açıklığını değerlendirmek için, 105 hastaya (%31.7) ameliyat sonrası ortalama 46.6±30.3 ayda kontrol koroner anjiyografisi yapıldı.Bulgular: Üç hasta (%0.9) erken dönemde, yedi hasta (%2.1) geç dönemde kaybedildi. Tam arteryel revaskülarizasyon grubunda hastanede kalış süresi (p=0.006) ve yara infeksiyonu sıklığının (p=0.021) anlamlı derecede düşük olduğu görüldü. Sağkalım oranları tam arteryel revaskülarizasyon uygulanan grupta 44. ayda %97.0±1.6, uygulanmayan grupta 64. ayda %94.9±2.0 bulundu (p=0.622). Sağkalım oranı LİMA+RİMA ve LİMA+RA grupları arasında anlamlı farklılık göstermedi (p=0.261). Anjiyografi yapılan hastalarda greft açıklık oranları LİMA, RA, RİMA ve safen ven grefti için sırasıyla %97.0 (96/99), %76.2 (48/63), %71.2 (37/52) ve %64.6 (42/65) bulundu. Radiyal arter tıkanıklığında düşük yaş (p=0.003) ve diyabetes mellitus varlığının (p=0.031) anlamlı etkisi görüldü.Sonuç: Koroner bypass ameliyatlarında, arteryel greftlerden ilk tercih edilecek olanın LİMA olduğunu, ikinci greft olarak RİMA veya RA’nın kullanılabileceğini düşünüyoruz.

Long-term angiographic results of coronary artery bypass surgery with the use of arterial graft combinations

Background: We examined the long-term results of coronary artery bypass surgery with the use of arterial graft combinations and evaluated the factors affecting graft patency. Methods: Between 1996 and 2002, a total of 331 patients (320 men, 11 women; mean age 46.9±7.3 years; range 28 to 69 years) underwent surgery with the use of arterial graft combinations. The left internal mammary artery (LIMA), radial artery (RA), and right internal mammary artery (RIMA) were used in 329, 192, and 147 patients respectively. In 281 patients, two arteries were used in combination (LIMA+RA in 178 patients, LIMA+RIMA in 103 patients). Complete arterial revascularization was performed in 182 patients (55%). The mean follow-up period was 45.3±25.5 months (range 1 to 113 months). To evaluate graft patency, control coronary angiographies were obtained in 105 patients (31.7%) after a mean of 46.6±30.3 months.Results: Early mortality occurred in three patients (0.9%), and late mortality in seven patients (2.11%). Length of hospital stay (p=0.006) and frequency of wound infections (p=0.021) were significantly less in patients treated with complete arterial revascularization. Survival rates were 97.0±1.6% and 94.9±2.0% after a mean of 44 months and 64 months in patients treated with or without complete arterial revascularization, respectively (p=0.622). Survival did not differ significantly between LIMA+RIMA and LIMA+RA groups (p=0.261). On control angiographies, graft patency rates were 97.0% (96/99), 76.2% (48/63), 71.2% (37/52) and 64.6% (42/65) for LIMA, RA, RIMA, and saphenous vein groups, respectively. Occlusion of RA grafts was significantly associated with younger age (p=0.003) and the presence of diabetes mellitus (p=0.031).Conclusion: Our results suggest that, among arterial grafts, the first choice can be made in favor of LIMA, combined with either RIMA or RA in coronary bypass operations.

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