Hilmi TOKMAKOĞLU, Hakan AYDIN, Serdar GÜNAYDIN, Kaya SÜZER, Bora FARSAK, Özer KANDEMİR, Cem YORGANCIOĞLU, Yaman ZORLUTUNA

Koroner bypass sonrası hastalarda greft açıklığı, hastalık ilerlemesi ve tekrar girişim oranının orta dönem anjiyografik değerlendirilmesi

Amaç: Bu retrospektif çalışmanın amacı pompalı ve pompasız koroner arter bypass cerrahisi (KABG) uygulanmış 619 hasta da orta-dönem anjiyografik sonuçları, hastalık ilerlemesi ve tekrar girişim oranının belirlenmesiydi. Materyal ve Metod: Haziran 1992 ile Aralık 2001 yılları arasında KABG uygulanmış 619 hastada (Pompalı KABG n: 509, pompasız KABG n: 110) ortalama 52.3 ± 15.8 ay sonra kontrol koroner anjiyografik muayene yapıldı. Toplam 1689 bypass değerlendirildi. Greftlerin açıklık oranları, yeni gelişmiş damar lezyonları ve re-intervasyonlar incelendi. Bulgular: Ortalama hasta yaşı pompalı grupta 55.2 ± 9.3, pompasız grupta 52.9 ± 10.1 yıl idi. Pompalı grupta hastaların %12.9 kadın iken pompasız grupta bu oran %21.8 idi. Operasyon ile anjiyografik değerlendirme arasında ki süre pompalı grupta 55.4 ± 17.6 ay, pompasız grupta ise 49.1 ± 12.8 aydı. Sol internal mammariyan arter ve safen ven greftleri'nin açıklık oranları pompalı grupta %93, %75.4, pompasız grupta %91 ve %66 idi. Pompalı grupta 131 olguda (%25.7) toplam 144 hemodinamik olarak anlamlı yeni damar lezyonu, 112 olguda (%22) toplam 126 tekrar girişim, pompasız grupta ise 29 olguda (%26.3) toplam 33 yeni damar lezyonu ve 23 olgu da (%20.9) toplam 23 tekrar girişim yapıldığı saptandı. Sonuç: Bu çalışmanın pompalı ve pompasız CABG uygulanan hastalarda orta-dönem anjiyografik sonuçlarının değerlendirilmesi açısından bir fikir verdiğine inanmaktayız. Daha fazla sayıda olgu içeren çağdaş yöntemlerle yapılacak tamamlayıcı çalışmalar gereklidir.

Mid-term angiographic evaluation of graft patency, disease progression and re-intervention rate in patients after CABG

Background: The aim of this retrospective study was; determination of mid-term angiographic results, the rate of disease progression and re-intervention of the 619 patients who had been operated with the techniques of on- pump and off-pump coronary artery bypass grafting (CABG). Methods: During the period from June 1992 until December 2001, control angiographic examinations were performed in 619 (On-Pump: 509, Off-Pump: 110) patients at an average of 52.3 ± 15.8 months after CABG. A total of 1689 anastomoses on 619 patients were evaluated. Patency rate of the grafts, newly developed vessel lesions, and re-interventions were noted. Results: Mean age was 55.2 ± 9.3 year in on-pump group and 52.9 ± 10.1 year in off-pump group respectively. The percentage of female patients was 12.9% in the on-pump group and 21.8% in the off-pump group. The mean interval from operation to angiographic examination was 55.4 ± 17.6 months and 49.1 ± 12.8 months respectively. The patency rate of the left internal mammary artery and saphenous vein graft was 93%, 75.4% in the on-pump group and 91%, 66% in the off-pump group. There were a total of 144 clinically significant newly developed lesions in 131 (25.7%) patients and a total of 126 reinterventions in 112 (22%) patients in the on-pump group and 33 clinically significant newly developed lesions in 29 (26.3%) patients and 23 reinterventions in 23 (20.9%) patients in the off-pump group. Conclusion: We believe our study may give an aspect for overall evaluations of the mid-term outcomes of CABG either on-pump or off-pump fashion. Further complementary studies with higher number of patients in contemporary methods are warranted.

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