Kaan KIRALİ, Cevat YAKUT, Mustafa GÜLER, Hasan EKİM, Veysel KUTAY

Van ve çevre illerde yaşayan koroner arter hastalarının profili ve CABG sonuçları

Amaç : Van Yüksek İhtisas Hastanesi'nde koroner bypass operasyonu gerçekleştirilen hastalardaki mevcut risk faktörlerinin ve koroner arter özelliklerinin cerrahi mortalite ve morbidite üzerine etkileri araştırılmıştır. Materyal ve Metod: Ocak 2000 ile Eylül 2002 tarihleri arasında ardışık olarak ameliyat edilen 200 olgu retrospektif olarak incelendi. Hastaların %82.5'i erkek olup, ortalama yaş 56 ± 9 yıl (28-76) idi. Hipertansiyon (%46), diyabet (%17), hiperlipidemi (%35), kronik obstrüktif akciğer hastalığı (%18), unstable anjina (%35), geçirilmiş miyokard enfarktüsü (%44), sol ana koroner lezyonu (%9), üç damar koroner lezyonu (%53.5), iskemik mitral yetersizliği (%7) ve sol ventrikül disfonksiyonu (ejeksiyon fraksiyonu < %40 (%14) olarak bulundu. Elli altı hastada (%28) koroner revaskülarizasyon atan kalpte gerçekleştirildi. Bulgular: Ortalama distal anastomoz sayısı 2.2 + 0.8 (1-5) idi. İntraaortik balon kullanımı 11 hastada (%5.5), peroperatif miyokard enfarktüsü 13 hastada (%6.5), hastane mortalitesi 12 hastada (%6) görüldü. İleri iskemik mitral yetersizliği olan 3 hastaya (%1.5) mitral kapak replasmanı, toplam 20 hastaya koroner endarterektomi yapıldı. Peroperatif olarak ciddi sol ventrikül disfonksiyonu, unstable anjina, yakın dönem geçirilmiş miyokard enfarktüsü, ileri kronik obstrüktif akciğer hastalığı, ciddi mitral yetersizliği varlığı mortaliteye etkili risk faktörleri olarak saptandı. Sonuç: Ameliyat edilen olguların koroner arter (uzun segment ve multipl plak varlığı, kalibrasyonu) ve uygulanan cerrahi girişim (endarterektomi, distal anastomoz sayısı) özelliklerinin erken dönem cerrahi morbidite ve mortalite üzerine etkili risk faktörleri olmadığı düşünüldü.

Profile and CABG results of coronary artery patients who live around Van and regional cities

Background: We sought to evaluate the impact of risk factors and characteristics of coronary arteries on surgical results of myocardial revascularization of the patients living around Van and regional cities. Methods: We analyzed retrospectively 200 patients who underwent coronary bypass operation between January, 2000 and September, 2002 in Van Yüksek İhtisas Hospital. One hundred-sixtyfive patients (82.5%) were male and thirty-five (17.5%) were female with a mean age of 56$pm$9 years (range 28 to 76 years). Coronary artery bypass grafting was performed in 56 patients (28%) with off-pump technique. Results: Hospital mortality was 6% with twelve patients. The mean number of bypassed grafts was 2.2 ± 0.8 (1-5). The rate of perioperative myocardial infarction was 6.5%, and intraaortic balloon pump was used in eleven patients (5.5%). Twenty patients (10%) received endarterectomy of at least one coronary artery. Preoperative risk factors associated with increased early mortality were recent postinfarction unstable angina pectoris, severe chronic obstructive pulmonary disease, low left ventricular ejection fraction (< 40%) and severe ischemic mitral regurgitation. Conclusions: Coronary artery characteristics such as diffuse-multiple plaque involvement and small calibration or surgical techniques such as the length of endarterectomy and number of bypassed grafts were non-significant effect on early surgical mortality and morbidity of coronary revascularization in our patients.

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