On-pump Versus Off-pump Coronary Bypass Surgery on Patients with Hemodialysis-Dependent Chronic Renal Failure

Yıl 2018, Cilt: 21 Sayı: 2, 122 - 127, 19.08.2018

Deniz Çevirme Kaan Kırali

Öz

Introduction: Coronary
baypas surgery has more mortality and morbidity risks in patients with chronic
renal failure than in individuals with normal functional kidneys. Therefore,
the selection of the most helpful medical treatment and surgical technique are
important for patient survival and surgical success of revascularization.

Patients and Methods:
Overall,
55 patients with hemodialysis-dependent chronic renal failure and who underwent
open heart surgery were retrospectively studied. Of them, 36 (65.5%) were male
and 19 (34.5%) were female, and the mean age was 61.2 ± 10.1 years (range,
34-83 years). Preoperative functional capacity was poor in 30% of patients, and
32 patients (58.2%) underwent complete revascularization and 23 patients
(41.8%) underwent incomplete revascularization.

Results: There was
no statistical difference between the two surgical techniques in terms of
mortality

(p= 0.476), with 32% mortality in off-pump technique and 23.4% in on-pump
technique. The complete revascularization procedure performed excess in the
on-pump technique. Complete revascularization rates in on-pump technique was
86.7% and those in off-pump technique was 24%, having a significant difference

(p< 0.001).

Conclusion: Achieving complete
revascularization should be the goal of coronary revascularization in patients
with chronic renal failure. On-pump technique is important in complete
revascularization procedure and intraoperative hemodialysis. Preoperative
support treatment (including intraaortic balloon pump and inotropic support)
must be used in patients with heart failure and in emergency surgeries because surgical
results are affected by the preoperative functional capacity.

Anahtar Kelimeler

Renal insufficiency, renal dialysis, coronary artery baypas

Diyalize Bağımlı Kronik Böbrek Yetmezlikli Hastalarda On-pump ve Off-pump Koroner Baypas Cerrahisi

Öz

Giriş: Kronik böbrek yetersizliği hastalarında uygulanan koroner
baypas cerrahisi normal böbrek fonksiyonlu hastalara göre daha yüksek mortalite
ve morbiditeye sahiptir. Kronik böbrek yetmezlikli diyalize giren ve kardiyopulmoner
baypas ve kardiyopulmoner baypas olmaksızın iki farklı cerrahi teknikle koroner
arter bypas greftleme ameliyatı geçiren hastaların sonuçları incelenmiştir.

Hastalar ve Yöntem: Koroner baypas cerrahisi yapılan 55
hasta bu çalışmaya dahil edildi. Bu hastalardan 36 (%65.5)’sı erkek ve 19
(%34.5)’u  kadındı. Ortalama yaş 61.24 ±
10.1 yıl (34-83). Olguların %30’unda preoperatif fonksiyonel kapasite kötüydü
(NYHA ortalaması 2.04 ± 0.81). Hastalardan 32 (%58.2)’sine tam ve 23
(%41.8)’üne  eksik revaskülarizasyon
uygulandı. Cerrahi yaklaşım  olarak  30 hastaya kardiyopulmoner baypas ve 25
hastaya kardiyopulmoner baypas olmadan uygulandı.

Bulgular: Hastaların ortalama ekstübasyon süresi 16.43 ± 11.89 saat
(5-72), yoğun bakımda ortalama kalış süre 6.63 ± 6.48 gün (2-30) idi. Hastane
mortalitesi 15 hasta ile %27.3, peroperatif miyokart infarktüs oranı %20 ve
inotrop destek oranı %27.3 olarak bulundu. Cerrahi teknikler arasında mortalite
açısından istatistiksel bir farklılık bulunmamakla birlikte (p= 0.476), KPB- grubunda
(%32) mortalite KPB+ grubuna (%23.4) göre daha fazla idi. Tam revaskülarizasyon
uygulaması kardiyopulmoner baypas grubunda (%86.7), kardiyopulmoner baypas
olmayan gruba (%24) göre anlamlı derecede daha fazla idi (p< 0.001).

Sonuç: Kronik böbrek
yetmezliğinde uygulanacak koroner baypas girişimlerinde hedef komplet
revaskülarizasyon olmalıdır. Bu amaçla ve gerekirse intraoperatif hemodiyaliz
uygulaması için kardiyopulmoner baypas tekniğinin seçilmesi daha uygun
görünmektedir. Preoperatif fonksiyonel kapasite operatif sonuçları
etkilediğinden, kalp yetmezliği bulunan veya acil ameliyata alınan hastalarda
preoperatif destek tedavisi (intraaortik balon pompası, inotrop destek) mutlaka
uygulanmalıdır.

Anahtar Kelimeler

Böbrek yetersizliği, hemodiyaliz, koroner baypas cerrahisi

Kaynakça

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