On-pump ve Off-pump Koroner Arter Bypass Greft Ameliyatı Yapılan Hastaların Cerrahi Sonuçlarının Karşılaştırılması

Year 2019, Volume: 21 Issue: 2, 112 - 117, 30.08.2019

Ertan Demirdaş , Gökhan Erol Erdem Çetin , Hüseyin Sicim , Hakan Kartal Gökhan Arslan

https://doi.org/10.18678/dtfd.534981

Abstract

Amaç: Bu çalışmanın amacı on-pump ve off-pump koroner arter baypass greftleme (KABG) yapılan hastaların klinik sonuçlarını retrospektif olarak güncel literatür ışığında değerlendirmektir.

Gereç ve Yöntemler: Çalışmaya Ekim 2014 ile Ağustos 2016 tarihleri arasında KABG uygulanan ve postoperatif sinüs ritmi olan toplam 1672 hasta dahil edildi. KABG yanında ek bir işlem uygulanmış ve KABG dışında açık kalp ameliyatı geçiren hastalar çalışma dışı bırakıldı. Toplam 1672 hastadan 783'üne off-pump KABG ve 889'una on-pump KABG uygulandı.

Bulgular: Operasyonel verilerin karşılaştırılmasında, operasyon süresi (p<0.001), koroner arter baypass sayısı (p<0.001), posterior desenden artere yapılan sağ koroner arter baypasslarının sayısı (p<0.001) ve yaygın koroner arter hastalığı (p<0.001), off-pump KABG grubunda daha azdı ve istatistiksel olarak anlamlı bir farklılık vardı. Ameliyat sonrası verilerin karşılaştırılmasında, ameliyat sonrası atriyal fibrilasyon gelişimi (p<0.001), entübasyon süresi (p<0.001), yoğun bakımda kalma süresi (p<0.001), hastanede kalma süresi uzunluğu (p<0.001), reeksplorasyon (p=0.006), vazopressör ilaç kullanımı (p<0.001), pozitif inotropik ilaç kullanımı (p<0.001), toplam drenaj (p<0.001), kullanılan kan ve kan ürünü (p<0.001) ve mortalite oranı (p=0.001) off-pump KABG grubunda daha azdı ve gruplar arasında istatistiksel olarak anlamlı bir farklılık olduğu bulundu.

Sonuç: Bu çalışmada off-pump KABG’nin birçok avantajı olduğu saptanmıştır. Koroner arter hastalığı olan seçilmiş bir hasta grubunda çalışan kalpte KABG uygulanması hastaları kardiyopulmoner baypassın morbidite ve mortaliteye neden olan negatif etkilerinden korur.

Keywords

Off-pump, on-pump, koroner arter baypass, kardiyopulmoner baypass

Comparison of Surgical Results of Patients Undergoing On-pump and Off-pump Coronary Artery Bypass Grafting

Abstract

Aim: The aim of this study is to evaluate the clinical results of the patients undergoing off-pump and on-pump coronary artery bypass grafting (CABG) retrospectively in consideration of current literature.

Material and Methods: A total of 1672 patients undergoing CABG between October 2014 and August 2016 and having a postoperative sinus rhythm were enrolled in the study. Patients who underwent an additional procedure in addition to CABG and underwent open heart surgery except CABG were excluded from the study. Off-pump CABG was applied to 783 and on-pump CABG to 889 of 1672 patients.

Results: In comparison of operative data, duration of operation (p<0.001), number of bypasses to the coronary arteries (p<0.001), number of bypasses of the right coronary artery to the posterior descending artery (p<0.001), and diffuse coronary artery disease (p<0.001) were less in the off-pump CABG group and there was a statistically significant difference. In comparison of postoperative data, postoperative atrial fibrillation development (p<0.001), intubation time (p<0.001), intensive care unit stay (p<0.001), length of hospital stay (p<0.001), reexploration (p=0.006), vasopressor drug usage (p<0.001), positive inotropic drug usage (p<0.001), total drainage (p<0.001), blood and blood product used (p<0.001), and mortality rate (p=0.001) were less in the off-pump CABG group and statistically significant difference was found between groups.

Conclusion: In this study, we found that off-pump CABG has many advantages. In a selected group of patients having a coronary artery disease performing CABG in beating heart would avoid the patient from morbid and mortal negative effects of cardiopulmonary bypass.

Keywords

Off-pump, on-pump, coronary artery bypass, cardiopulmonary bypass

References

• Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 1993;55(2):552-9.
• Westaby S. Organ dysfunction after cardiopulmonary bypass: a systemic inflammatory reaction initiated by the extracorporal circuit. Intensive Care Med. 1987;13(2):89-95.
• Blauth CI, Cosgrove DM, Webb BW, Ratliff NB, Boylan M, Piedmonte MR, et al. Atheroembolism from the ascending aorta: an emerging problem in cardiac surgery. J Thorac Cardiovasc Surg. 1992;103(6):1104-12.
• Cleveland JC Jr, Shroyer AL, Chen AY, Peterson E, Grover FL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg. 2001;72(4):1282-9.
• Yanagawa B, Puskas JD. Off-pump coronary artery bypass grafting. Oper Tech Thorac Cardiovasc Surg. 2016;21(1):2-19.
• Mathison M, Edgerton JR, Horwell JL, Akin JJ, Mack MJ. Analysis of hemodynamic changes during beating heart surgical procedure. Ann Thorac Surg. 2000;70(4):1355-61.
• Ehsan A, Shekar P, Aranki S. Innovative surgical strategies: minimally invasive CABG and off-pump CABG. Curr Treat Options Cardiovasc Med. 2004;6(1):43-51.
• Buffolo E, de Andrade CS, Branco JN, Teles CA, Aguiar LF, Gomes WJ. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg. 1996;61(1):63-6.
• Calafiore AM, Di Mauro M, Canosa C, Cirmeni S, Iacò AL, Contini M, et al. Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease: impact of strategy on midterm outcome. Ann Thorac Surg. 2003;76(1):32-6.
• Yoon SS, Bang JH, Jeong SS, Jeong JH, Woo JS. Risk factors of on-pump conversion during off-pump coronary artery bypass graft. Korean J Thorac Cardiovasc Surg. 2017;50(5):355-62.
• Plomondon ME, Cleveland JC Jr, Ludwig ST, Grunwald GK, Kiefe CI, Grover FL, et al. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg. 2001;72(1):114-9.
• Hoff SJ, Ball SK, Coltharp WH, Glassford DM Jr, Lea JW 4th, Petracek MR. Coronary artery bypass in patients 80 years and over: is off-pump the operation of choice? Ann Thorac Surg. 2002;74(4):S1340-3.
• Sepehripour AH, Harling L, Ashrafian H, Casula R, Athanasiou T. Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies. J Cardiothorac Surg. 2014;9:115.
• García Fuster R, Paredes F, García Peláez A, Martín E, Cánovas S, Gil O, et al. Impact of increasing degrees of renal impairment on outcomes of coronary artery bypass grafting: the off-pump advantage. Eur J Cardiothorac Surg. 2013;44(4):732-42.
• Keeling WB, Williams ML, Slaughter MS, Zhao Y, Puskas JD. Off-pump and on-pump coronary revascularization in patients with low ejection fraction: a report from the society of thoracic surgeons national database. Ann Thorac Surg. 2013;96(1):83-9.
• Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet. 2002;359(9313):1194-9.
• van Dijk D, Nierich AP, Jansen EW, Nathoe HM, Suyker WJ, Diephuis JC, et al. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation. 2001;104(15):1761-6.
• Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, et al. Off-pump coronary artery bypass grafting provides complete revascularisation with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(4):797-808.
• Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study. Ann Thorac Surg. 1999;68(6):2237-42.
• Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med. 2016;375(24):2359-68.
• Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, et al. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009;361(19):1827-37.
• Adams DH, Chikwe J. On-pump CABG in 2018: still the gold standard. J Am Coll Cardiol. 2018;71(9):992-3.
• Puskas JD, Martin J, Cheng DC, Benussi S, Bonatti JO, Diegeler A, et al. ISMICS consensus conference and statements of randomized controlled trials of off-pump versus conventional coronary artery bypass surgery. Innovations (Phila). 2015;10(4):219-29.