Haşim ÜSTÜNSOY, Hakkı KAZAZ, Adnan CELKAN, Rengin HAYTA, Hasan KOÇOĞLU

Off-pump koroner arter cerrahisinde hemodinamik değişimlerin transözofegeal ekokardiyografi ile izlenmesi

Amaç: Off-pump koroner arter bypass cerrahisi (OPCAB) sırasında hemodinamik izlemenin önemli olduğu düşünülmekle birlikte, henüz standart yöntemler belirlenmemiştir. Özfageal Doppler ultrasonografi ile aortik kan akımı ölçümlerine dayalı hemodinamik monitörizasyon etkili ve non-invaziv bir yöntemdir. Çalışmamızda OPCAB sırasındaki hemodinamik değişimler bu yöntem kullanılarak incelendi. Materyal ve Metod: "Starfish" kalp pozisyon verici sistem ve "octopus III" doku sabitleyici sistem kullanılarak çok damar, tam cerrahi revaskülarizasyon yapılan 30 olgu çalışmaya alındı. Özfageal Doppler ultrasonografi kullanılarak kardiyak debi (CO), aort kan akımı, toplam sistemik vasküler direnç, peak velosite, atım hacmi maksimum akselerasyon, sol ventrikül ejeksiyon zamanı, kalp hızı, ortalama kan basıncı ve aort çapı ölçümleri yapıldı. Hemodinamik parametreler değerlendirildi. Bulgular: Sol ön inen arterin oklüzyonu sonucunda CO belirgin olarak azaldı (Z = - 2.584, p = 0.01). Anastomoz sonrası klemp kaldırılınca iki dakika içerisinde tekrar giriş değerlerine yaklaştı (Z = -0.773, p = 0.438). Sağ koroner arter arka inen dalı ve sirkumfleks koroner arter anastomozlan sırasında hemodinamik parametrelerde istatistiksel olarak anlamlı bir değişiklik oluşmadı. Tüm anastomozlar tamamlandıktan sonra CO'da belirgin düzelme oldu (Z = 2.121, p = 0.034).Sonuç: Off-pump koroner arter bypass cerrahisi sırasında en önemli sorun kalbin verilen pozisyonn tolere edip edemeyeceğidir. Bu sırada kabul edilmiş bir monitörizasyon yöntemi yoktur. Özfageal ekokardiyografi Swan-Ganz kateteri kadar duyarlı sonuçlan non-invaziv olarak veebilmektedir.

The hemodynamic monitorization during off pump coronary artery bypass surgery by transesophageal ecocardiography

Background: During off-pump surgery hemodynamic monitoring is very important but it has not been standardized. Determination of aortic blood flow using esophageal Doppler has been proposed as a low invasive hemodynamic monitoring method. We aimed to investigate the hemodynamic changes during off-pump coronary bypass with esophageal Doppler. Methods: Thirty patients who were multivessel completly revascularized with off-pump coronary artery bypass technique by using the octopus III stabilizator and Starfish heart positioner (Medtronic Minneapolis MN) were received in the study. The esophageal echo - doppler system was used for monitorization of the hemodynamic parameters; cardiac output (CO), aortic blood flow (ABF), total systemic vascular resistance (TSVR), peak velocity (PV), stroke volume (SV), acceleration (Ace), left ventricular ejection time (LVET), heart rate, mean arterial blood pressure and aortic diameter. Results: After clamping the left arterior descending artery (LAD) with bulldog clamp for anastomosis there was a significant decrease at the CO (Z = -2.584 p = 0.01). After reperfusing the LAD, CO increased the basic value in 2 minutes (Z = -0.773 p = 0.438) During PDA and Cx anastomosis there were no significant CO decreasing. After reperfusing all coronary arteries there was a significant increase (Z = 2.121 p = 0.034). Conclusions: During the off-pump surgery the most important point is whether the heart tolaretes the heart position during off-pump surgery or not. Also monitorization technique has not been well accepted. The esophageal echo doppler offers accuracy equal that of the right heart catheter but in a noninvasive way.

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