Diyabetik Yaşlı ve İleri Yaş Hasta Gruplarında Atan Kalpte Koroner Arter Cerrahisinin Perioperatif ve Klinik Sonuçları

Yıl 2016, Cilt: 6 Sayı: 2, 81 - 86, 19.10.2016

Suleyman Surer , İlker Ince Ali Bulut Uğursay Kızıltepe

https://doi.org/10.16899/ctd.41638

Öz

Giriş: İleri yaş diyabetik hastalarda koroner arter cerrahisine bağlı perioperatif mortalite ve morbidite riski mevcuttur. Çalışmamızda yaşlı (Grup I) ve ileri yaş (Grup II) diyabetik hasta gruplarında atan kalpte koroner arter cerrahisinin risk faktörlerini ve sonuçlarını karşılaştırmayı amaçladık.

Gereç ve Yöntem: Bu çalışma hastanemizde geriye dönük olarak izole atan kalpte koroner cerrahisi yapılan 37 diyabetik hasta yaş gruplarına göre 65 yaş ve üzeri olanlar alındı. Çalışmaya 65 - 75 yaş arasında 25 hasta ve 76 yaş ve üzerinde 12 hasta dahil edildi. Grupların preoperatif ve operatif özellikleri ile ameliyat sonrası sonuçları karşılaştırıldı.

Bulgular: Yaşlı hastalar, ileri yaşlı grubunda olan hastalarla karşılaştırıldığında; ortalama arteryel anastomoz sayısı (p=0.045), vücut kitle indeksi (P=0.001), sigara kullanımı (p=0.027) ve ACE inhibitörü kullanımı (p=0.027) istatistiksel olarak yüksek bulundu. İleri yaşlı grubunda ise ortalama venöz anastomoz sayısı (1.5±0.61 vs 2.25±0.75, p= 0.008) istatistiksel olarak anlamlı bulundu.

Sonuç: Her iki grupta da beklenenden daha uzun yaşam süreleri nedeniyle koroner arter cerrahisi sıklığı artmaktadır. Her iki grupta da atan kalpte koroner arter cerrahisinin daha faydalı bir yöntem olarak önermekteyiz. 

 

Anahtar Kelimeler

Yaşlı, ileri yaşlı, diyabetik, atan kalpte koroner arter cerrahisi

Off-Pump Coronary Artery Surgery in Diabetic Elderly and Octogenerian Groups :Perioperative Outcome and Clinical Results

Öz

-Increased risk for perioperative morbidity and mortality after beating heart coronary artery bypass grafting(CABG) in diabetic octogenarians (Group II) and elderly (Group I) can be in question. We aimed to compare the risk factors and the results of off-pump CABG between diabetic elderly and octogenarian groups .Methods- This study retrospectively enrolled 37 diabetic patients with an age equal to or greater than 65 years who underwent isolated OPCAB at our department . Twenty-five patients were between 65 and 75 years of age while 12 patients had an age equal to or greater than 76 years. Each study group was assessed for preoperative properties, operative characteristics, and postoperative outcomes. Results-Elderly patients had a significantly higher mean number of arterial anastomoses (p=0.045), body mass index (BMI) (P=0.001), number of smoking subjects (p=0.027), and number of subjects using ACE inhibitors (P=0.027) compared to the octogenarians. Octogenarians had a significantly greater mean number of venous grafts (1.5±0.61 vs 2.25±0.75, p= 0.008).Conclusions-People of advanced age have been increasingly operated with CABG operation as persons 80 years old or older live longer than previously expected. Off-pump CABG was a beneficial surgical coronary revascularization method for both elderly and octogenarian patients-

Anahtar Kelimeler

Elderly, octogenarians, diabetic, off-pump coronary artery bypass grafting

Kaynakça

• Stamou SC, Dangas G, Dullum MKC, Pfister AJ, Boyce SW, Bafi AS, et al. Beating heart surgery in octogenari- ans: perioperative outcome and comparison with yo- unger age groups. Ann Thorac Surg 2000; 69: 1140–5. (PMID:10800808).
• Curtis JJ, Walls JT, Boley TM, Schmaltz RA, Demmy TL, Salam N. Coronary revascularization in the elderly: determinants of operative mortality. Ann Thorac Surg 1994; 58: 1069–72. (PMID:7944752).
• D. S. Fruitman, C. E. MacDougall and D. B. Ross. “Car- diac Surgery in Octogenarians: Can Elderly Patients Benefit? Quality of Life after Cardiac Surgery,” Ameri- can Journal of Cardiology, 1999;68(6): 2129- 2135.( PMID:10616989).
• Peterson ED, Cowper PA, Jollis JG, Bebchuk JD, De- Long ER, Muhlbaier LH, et al. Outcomes of coronary artery bypass graft surgery in 24,461 patients aged 80 years or older. Circulation 1995; 92 (II):85-91. (PMID:7586468).
• Williams DB, Carrillo RG, Traad EA, Wyatt CH, Gra- howksi R, Wittels SH, et al. Determinants of opera- tive mortality in octogenarians undergoing coro- nary bypass. Ann Thorac Surg 1995; 60: 1038– 43.( PMID:7574944).
• Ko W, Krieger KH, Lazenby S, Shin YT, Goldstein M, Laz- zaro R ,et al. Isolated coronary artery bypass grafting in one hundred consecutive octogenarian patients: a multivariate analysis. J Thorac Cardiovasc Surg 1991; 102: 532–8.( PMID:1681137).
• Trehan N, Mishra M, Sharma OP, Mishra A, Kasliwal R. Further reduction in stroke after off-pump coronary artery bypass grafting: a 10-year experience. Ann Tho- rac Surg 2001; 72: 1026–32. (PMID:11565720).
• Ascione R, Nason G, Al-Ruzzeh S, Ko C, Ciulli F, Ange- lini GD. Coronary revascularization with and without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency. Ann Thorac Surg 2001; 72: 2020–5.( PMID:11789787).
• 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: 1340–3. (PMID:12400813).
• 10. Freeman WK, Schaff HV, O’Brian PC, Orszulak TA, Naessens JM, Tajik AJ. Cardiac surgery in the octogena- rians: perioperative outcome and clinical follow-up.J Am Coll Cardiol 1991; 18: 29–35. (PMID:1904893).
• Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH et al. Longitudinal assess- ment of neurocognitive function after coronary artery bypass surgery. N Engl J Med 2001; 344: 395–402. (PMID:11172175).
• Hiroyuki Tanaka ,Takashi Narisawa,Mikio Masuda, Da- izirou Kishi ,Takashi Suzuki. Coronary Artery Bypass in Patients 80 Years and Older:Comparison with a Youn- ger Age Group Age Group. Ann Thorac Surg 2004;10: 85-89.( PMID:15209549).
• Eagle KA Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery. A report of the American College ofCardiology/American Heart Association Task Force on Practice Guidelines (Com- mittee to update the 1999 guidelines for coronary ar- tery bypass graft surgery). Circulation 2004;1(9):1168- 76.( PMID:15339866).
• Alexander KP, Anstrom KJ, Muhlbaier LH, Grosswald RD, Smith PK, Jones RH,et al. Outcomes of cardiac surgery in patients > or =80 years: results from the National Cardiovascular Network. J Am Coll Cardiol 2000;35:731–738.( PMID:10716477).
• Speziale G, Nasso G, Barattoni M.C, Esposito G, Pop- off G, Argano V, et al. “Short-Term and Long-Term Results of Cardiac Surgery in Elderly and Very Elderly Patients,” The Journal of Thoracic and Cardiovascular Surgery 2011;141(3): 725-731. (PMID:20646718).
• Ullery B.W, Peterson J.C, Milla F, Wells M.T, Briggs W, Girardi L.N, et al. “Cardiac Surgery in Select No- nagenarians: Should We or Shouldn’t We?” .The Annals of Thoracic Surgery 2008; 85(3): 854-860. (PMID:18291156) .
• Bridges C.R, Edwards F.H, Peterson E.D, Coombs L.P and Ferguson T.B. “Cardiac Surgery in Nonagenarians and Centenarians”. Journal of the American College of Surgeons 2003;197(3): 347-356. (PMID:12946784).