Kemal UZUN, Adil POLAT, Bülent MERT, Esat AKINCI, Cenk TATAROĞLU, Ali Rıza CENAL, Hayrettin TEKÜMİT

Mid-term results of coronary artery bypass graft surgery in patients 70 years of age or older

Amaç: Bu çalışmada 70 yaş ve üzeri hastalarda uygulanan koroner arter baypas greft (KABG) cerrahisinin orta dönem sonuçları incelendi. Çalışma planı: Eylül 2001 - Haziran 2009 tarihleri arasında izole kardiyopulmoner koroner arter baypas greft uygulanmış olan 70 yaş ve üzerindeki 621 hasta (453 erkek, 168 kadın; ort. yaş 73.6±2.9 yıl; dağılım 70-89 yıl) retrospektif olarak incelendi. Bu hastaların 604’ü (%97.3) ameliyat sonrasında takip edildi. Ortalama takip süresi 2.5±1.4 yıl (dağılım 0.3-6.9 yıl) ve toplamda 1532.5 hasta/yıl idi. Bulgular: Hasta başına yapılan ortalama distal anastomoz ve greft sayısı, sırasıyla ortalama 3.0±0.7 (dağılım 2-5) ve 2.8±1.1 (dağılım 2-5) idi. Otuz günlük mortalite %2.7 (n=17) idi. Sağ kalan 604 hastanın 30’u (%4.8) takip sürecinde kaybedildi. Hastaların ortalama sağkalım süreleri 3.1±1.9 (dağılım 0.8-6.7) yıl idi. Ameliyat öncesi ileri NYHA fonksiyonel sınıf ve ameliyat sonrası renal komplikasyonlar, artmış geç mortalite ile ilişkili iken, ameliyat öncesi eşlik eden diyabet ve sol internal torasik arter greftinin kullanılması daha düşük mortalite oranları ile ilişkili bulundu. Sonuç: Çalışma bulgularımız, 70 yaş ve üzerindeki hastaların KABG ameliyatından fayda görebileceğini göstermektedir. Erken mortalite hastaya özel faktörlerle ilişkiliyse de, orta dönem mortalite renal komplikasyonlar ve ameliyat öncesi ileri NYHA fonksiyonel sınıf ile ilişkilidir. Orta dönem takipte ise, en fazla faydayı KABG ameliyatı sırasında sol internal torasik arter g refti kullanılan diyabetik hastalar görmektedir.

Koroner arter baypas greft cerrahisinin 70 yaş ve üzeri hastalarda orta dönem sonuçları

Background: This study aims to analyze the mid-term results of the coronary artery bypass graft (CABG) surgery in a group of patients 70 years of age or over. Methods: Between September 2001 and June 2009, 621 patients who were more than 70 years of age (453 males, 168 females; mean age 73.6±2.9 years; range 70 to 89 years) who underwent isolated cardiopulmonary CABG were analyzed retrospectively. Of these patients, 604 (97.3%) were followed up postoperatively. The mean duration of the follow-up was 2.5±1.4 years (range 0.3-6.9 years) with a total of 1532.5 patient/years. Results: The mean number of distal anastomoses and grafts per patient was 3.0±0.7 (range 2-5) and 2.8±1.1 (range 2-5), respectively. The 30-day mortality rate was 2.7% (n=17). Of the surviving 604 patients, 30 (4.8%) died during the follow-up period. The mean survival of these patients was 3.1±1.9 years (range 0.8-6.7 years). The preoperative advanced NYHA functional class and postoperative renal complications were associated with increased late mortality while comorbid preoperative diabetes and the use of the left internal thoracic artery graft were associated with lower mortality. Conclusion: Our study results suggest that patients who were more than 70 years old may benefit from CABG surgery. We found that early mortality is related to patientspecific factors, while mid-term mortality is associated with renal complications and preoperative advanced NYHA functional class. Diabetic patients who were administered left internal thoracic artery grafts benefit the most from CABG surgery during the mid-term follow-up.

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