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Sağ koroner arteri oklude hastalarda kombine antegrad ve selektif koroner greft kardiyopleji iletim defektlerini azaltır mı?

Year 2018, , 1 - 5, 02.02.2018

Oğuz Uğur , Mehmet Kalender Hayat Gökmengil Hakan Bingöl

https://doi.org/10.28982/josam.368728

Abstract

Amaç: Koroner arter bypass grefti (CABG) sonrası iletim bozukluklarının birçok farklı sebebi olabilir. Biz çalışmamızda proksimal sağ koroner arter (RCA) oklude olan hastalarda antegrad ve devamlı RCA selektif kardiyopleji uygulanmasının, aralıklı antegrad ve devamlı retrograd kardiyopleji uygulamasına kıyasla koroner bypass cerrahisi sonrası görülen postoperatif ritm bozukluklarına etkisini değerlendirdik. 

Materyal ve Metot: Bu çalışmada 2011 ile 2017 yılları arasında proksimal RCA oklude olan ve izole CABG yapılmış 104 hasta retrospektif olarak değerlendirilmiştir. Bu hastalardan 43 (%41,4)’ü kadın idi. Postoperatif erken dönemde gelişen sağ dal bloğu, sol dal bloğu, sol ön dal hemiblok, sol arka dal hemiblok ve 3. derece atriyoventriküler (AV) bloklar değerlendirildi. 

Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşı 55,54±4,42 idi (dağılım 46-65 yıl). Preoperatif ve intraoperatif özellikler açısından gruplar arasında anlamlı farklılık yoktu. Ancak postoperatif ritm bozukluğu görülen hastalar sayıca Grup 1 de fazla olsa da istatistiksel anlamlılık kazanmadı (Grup 1: 9 hasta ve Grup 2: 4 hasta p=0,378). Hastane yatış süresi ve yoğun bakımda kalış süresi açısından gruplar arasında Grup 2 lehine anlamlı istatistiksel fark vardı (Grup 1 ortalama hastane yatış süresi 7,40±1,31 gün ve Grup 2 ortalama hastane yatış süresi 6,53±1,19 gün p=0,026. Grup 1 yoğun bakım kalış süresi 2,20±0,67 gün ve Grup 2 yoğun bakım kalış süresi 1,87±0,72 gün p=0,021).

Sonuçlar: Antegrad kardiyoplejiye ek devamlı RCA selektif kardiyopleji uygulamasının CABG sonrası ritm bozukluğunu önlemede daha başarılı olabileceğini düşünmekteyiz.

Keywords

Kardiyopleji Myokardiyal koruma İletim bozuklukları

References

  • 1. Gundry S, Sequeira A, Coughlin T, McLaughlin J. Postoperative conduction disturbances: a comparison of blood and crystalloid cardioplegia. Ann Thorac Surg 1989;47:38-90.
  • 2. Caretta Q, Mercanti C, DeNardo D, Chiarotti F, Scibilia G, Reale A. et al. Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting. Multivariate analysis of preoperative, intraoperative and postoperative variables. Eur Heart J 1991;12:1107-11.
  • 3. Pattison C, Dimitri W, Williams B. Persistent conduction disturbances following coronary artery bypass surgery: cold cardioplegic vs. intermittent ischemic arrest (32°C). Scand J Thorac Cardiovasc Surg 1991;25:151-4.
  • 4. Mustonen P, Hippelainen M, Rehnberg S. Low myocardial temperatures are associated with postoperative conduction defects after coronary artery bypass surgery. Ann Chir Gynaecol 1995;84:44-50.
  • 5. Aronson S, Jacobsohn E, Savage R, Albertucci M. The influence of collateral flow on the antegrade and retrograde distribution of cardioplegia in patients with an occluded right coronary artery. Anesthesiology 1998;89(5):1099-107.
  • 6. Allen BS, Winkelmann JW, Hanafy H, Hartz RS, Bolling KS, Ham J, et al. Retrograde cardioplegia does not adequately perfuse the right ventricle. J Thorac Cardiovasc Surg 1995;109(6):1116-24.
  • 7. Buckberg G. A proposed "solution" to the cardioplegic controversy. J Thorac Cardiovasc Surg 1979;77:803–15.
  • 8. Soltesz EG, Laurence RG, De Grand AM, Cohn LH, Mihaljevic T, Frangioni JV. Image guided quantification of cardioplegia delivery during cardiac surgery. Heart Surg Forum 2007;10:E381-6.
  • 9. Partington, M, Acar, C, Buckberg, G, Julia, P, Kofsky, E, and Bugyi, H. Studies of retrograde cardioplegia. I. Capillary blood flow distribution to myocardium supplied by open and occluded arteries. J Thorac Cardiovasc Surg 1989;97:605–12.
  • 10. Gates, R, Laks, H, Drinkwater, DC, Pearl J, Zaragoza AM, Kaczer E, .et al. The microvascular distribution of cardioplegic solution in the piglet heart: retrograde versus antegrade delivery. J Thorac Cardiovasc Surg 1993;105:845–53.
  • 11. Stirling, M.C, McClanahan, T.B, Schott, R.J Lynch MJ, Bolling SF, Kirsh MM. et al. Distribution of cardioplegic solution infused antegradely and retrogradely in normal canine hearts. J Thorac Cardiovasc Surg1989;98:1066–76.
  • 12. Borger MA, Wei KS, Weisel RD, Ikonomidis JS, Rao V, Cohen G, et al. Myocardial perfusion during warm antegrade and retrograde cardioplegia: a contrast echo study. Ann Thorac Surg 1999;68(3):955-61.
  • 13. Kulshrestha P, Rousou JA, Engelman RM, Flack JE 3rd, Deaton DW, Wait RB, et al. Does warm blood retrograde cardioplegia preserve right ventricular function? Ann Thorac Surg 2001;72(5):1572-5.
  • 14. Ruengsakulrach P, Buxton BF.Anatomic and hemodynamic considerations influencing the efficiency of retrograde cardioplegia. Ann Thorac Surg 2001;71(4):1389-95.
  • 15. Onem G, Sacar M, Baltalarli A, Ozcan AV, Gurses E, Sungurtekin H. Comparison of simultaneous antegrade/vein graft cardioplegia for myocardial protection. Adv in Therapy 2006;23:869-77.
  • 16. Gursoy M, Bakuy V, Hatemi AC. Delivering Cardioplegia Beyond Totally Occluded Native Coronary Arteries Through the Saphenous Bypass Vein Graft: Is It Really a Protective Technique? Kosuyolu Kalp Derg 2012;15(3):100-4.
  • 17. Mustonen P, Hippelainen M, Vanninen E, Rehnberg S, Tenhunen- Eskelinen M, et al. Significance of coronary artery bypass grafting associated conduction defects. Am J Cardiol 1996;81:558-63.
  • 18. Tuzcu EM, Emre A, Goormastic M, Loop FD, Underwood DA. 1990. Incidence and prognostic significance of intraventricular conduction abnormalities after coronary bypass surgery. J Am Coll Cardiol 1990;16:607-10.
  • 19. Kloner RA, Przklenk K, and Whittaker P. Deleterious effects of oxygen radicals in ischemia/reperfusion (Resolved and unresolved issues) Circ 1989;80(5):1115-23.
  • 20. Ekim H, Yilmaz YK, Ekim M. Izotermik hiperkalemik kan kardiyoplejisinin myokard korunmasında önemi. Bozok Tıp Derg 2015;5(2):56-64.
  • 21. Caspi J, Ammar R, Elami A, Safadi T, Merin G. Frequency and significance of complete atrioventricular block after coronary artery bypass grafting. Am J Cardiol 1989;63:526-9.
  • 22. Seitelberger R, Wild T, Serbecic N, Schwarzacher S, Ploner M, Lassnigg A. et al. Significance of right bundle branch block in the diagnosis of myocardial ischemia in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg 2000;18:187-93.
  • 23. Pehkonen EJ, Honkonen EL, Makynen PJ, Kataja MJ, Tarkka MR. Conduction disturbances after different blood cardioplegia modes in coronary artery bypass grafting. Including comparison with an earlier patient series. Scand J Thorac Cardiovasc Surg 1996;30:149-55.
  • 24. Ueyama K, Jones JW, Ramchandani M, Beall AC, Thornby JI. Clinical variables influencing the appearance of right bundle branch block after cardiac surgery. Cardiovasc Surg 1997;5:574-8.
  • 25. Mosseri M, Meir G, Lotan C, Hasin Y, Applebaum A, Rosenheck S, et al. Coronary pathology predicts conduction disturbances after coronary artery bypass grafting. Ann Thorac Surg 1991;51:248-52.

Does combined antegrade and selective coronary graft cardioplegia reduce conduction defects in right coronary artery occluded patients?

Year 2018, , 1 - 5, 02.02.2018

Oğuz Uğur , Mehmet Kalender Hayat Gökmengil Hakan Bingöl

https://doi.org/10.28982/josam.368728

Abstract

Aim: Post coronary artery bypass grafting (CABG) procedure conduction disturbances may appear due to many reasons. In this particular study we compared postoperative cardiac rhythm disturbances in right coronary artery (RCA) occluded patients, which cardioplegia disturbed with antegrade aortic and continuous retrograde way versus antegrade plus continue right coronary graft.

Methods: A total of 104 patients with right coronary artery occlusion who underwent isolated CABG procedure between 2011 and 2017 were included. The number of female patients was 43 (41.4%).  Left bundle branch, left branch hemi block, and left branch hemi block and 3rd degree atrioventricular (AV) blocks were evaluated in the early postoperative period.

Results: The mean age of patients was 55.54±4.42 years (range 46-65 years). There was no statistical difference among groups according to preoperative and intraoperative demographics. Postoperative rhythm disturbances were higher in Group 1 but there was no statistical difference. (Group 1: 9 patients and Group 2: 4 patients. p=0.378). Hospital stay and intensive care unit (ICU) stay had statistically significant difference among groups (Group 1 mean hospital stay was 7.40±1.31 days and Group 2 had mean 6.53±1.19 days p=0.026 and Group 1 mean ICU stay was days 2.20±0.67 and Group 2 had mean 1.87±0.72 days p=0.021). 

Conclusion: We believe that continuous RCA-selective cardioplegia administration in addition to antegrade cardioplegia may be more successful in terms of prevention of postoperative rhythm disturbances in postoperative CABG applied patients.

Keywords

Cardioplegia Myocardial protection Conduction disturbance

References

  • 1. Gundry S, Sequeira A, Coughlin T, McLaughlin J. Postoperative conduction disturbances: a comparison of blood and crystalloid cardioplegia. Ann Thorac Surg 1989;47:38-90.
  • 2. Caretta Q, Mercanti C, DeNardo D, Chiarotti F, Scibilia G, Reale A. et al. Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting. Multivariate analysis of preoperative, intraoperative and postoperative variables. Eur Heart J 1991;12:1107-11.
  • 3. Pattison C, Dimitri W, Williams B. Persistent conduction disturbances following coronary artery bypass surgery: cold cardioplegic vs. intermittent ischemic arrest (32°C). Scand J Thorac Cardiovasc Surg 1991;25:151-4.
  • 4. Mustonen P, Hippelainen M, Rehnberg S. Low myocardial temperatures are associated with postoperative conduction defects after coronary artery bypass surgery. Ann Chir Gynaecol 1995;84:44-50.
  • 5. Aronson S, Jacobsohn E, Savage R, Albertucci M. The influence of collateral flow on the antegrade and retrograde distribution of cardioplegia in patients with an occluded right coronary artery. Anesthesiology 1998;89(5):1099-107.
  • 6. Allen BS, Winkelmann JW, Hanafy H, Hartz RS, Bolling KS, Ham J, et al. Retrograde cardioplegia does not adequately perfuse the right ventricle. J Thorac Cardiovasc Surg 1995;109(6):1116-24.
  • 7. Buckberg G. A proposed "solution" to the cardioplegic controversy. J Thorac Cardiovasc Surg 1979;77:803–15.
  • 8. Soltesz EG, Laurence RG, De Grand AM, Cohn LH, Mihaljevic T, Frangioni JV. Image guided quantification of cardioplegia delivery during cardiac surgery. Heart Surg Forum 2007;10:E381-6.
  • 9. Partington, M, Acar, C, Buckberg, G, Julia, P, Kofsky, E, and Bugyi, H. Studies of retrograde cardioplegia. I. Capillary blood flow distribution to myocardium supplied by open and occluded arteries. J Thorac Cardiovasc Surg 1989;97:605–12.
  • 10. Gates, R, Laks, H, Drinkwater, DC, Pearl J, Zaragoza AM, Kaczer E, .et al. The microvascular distribution of cardioplegic solution in the piglet heart: retrograde versus antegrade delivery. J Thorac Cardiovasc Surg 1993;105:845–53.
  • 11. Stirling, M.C, McClanahan, T.B, Schott, R.J Lynch MJ, Bolling SF, Kirsh MM. et al. Distribution of cardioplegic solution infused antegradely and retrogradely in normal canine hearts. J Thorac Cardiovasc Surg1989;98:1066–76.
  • 12. Borger MA, Wei KS, Weisel RD, Ikonomidis JS, Rao V, Cohen G, et al. Myocardial perfusion during warm antegrade and retrograde cardioplegia: a contrast echo study. Ann Thorac Surg 1999;68(3):955-61.
  • 13. Kulshrestha P, Rousou JA, Engelman RM, Flack JE 3rd, Deaton DW, Wait RB, et al. Does warm blood retrograde cardioplegia preserve right ventricular function? Ann Thorac Surg 2001;72(5):1572-5.
  • 14. Ruengsakulrach P, Buxton BF.Anatomic and hemodynamic considerations influencing the efficiency of retrograde cardioplegia. Ann Thorac Surg 2001;71(4):1389-95.
  • 15. Onem G, Sacar M, Baltalarli A, Ozcan AV, Gurses E, Sungurtekin H. Comparison of simultaneous antegrade/vein graft cardioplegia for myocardial protection. Adv in Therapy 2006;23:869-77.
  • 16. Gursoy M, Bakuy V, Hatemi AC. Delivering Cardioplegia Beyond Totally Occluded Native Coronary Arteries Through the Saphenous Bypass Vein Graft: Is It Really a Protective Technique? Kosuyolu Kalp Derg 2012;15(3):100-4.
  • 17. Mustonen P, Hippelainen M, Vanninen E, Rehnberg S, Tenhunen- Eskelinen M, et al. Significance of coronary artery bypass grafting associated conduction defects. Am J Cardiol 1996;81:558-63.
  • 18. Tuzcu EM, Emre A, Goormastic M, Loop FD, Underwood DA. 1990. Incidence and prognostic significance of intraventricular conduction abnormalities after coronary bypass surgery. J Am Coll Cardiol 1990;16:607-10.
  • 19. Kloner RA, Przklenk K, and Whittaker P. Deleterious effects of oxygen radicals in ischemia/reperfusion (Resolved and unresolved issues) Circ 1989;80(5):1115-23.
  • 20. Ekim H, Yilmaz YK, Ekim M. Izotermik hiperkalemik kan kardiyoplejisinin myokard korunmasında önemi. Bozok Tıp Derg 2015;5(2):56-64.
  • 21. Caspi J, Ammar R, Elami A, Safadi T, Merin G. Frequency and significance of complete atrioventricular block after coronary artery bypass grafting. Am J Cardiol 1989;63:526-9.
  • 22. Seitelberger R, Wild T, Serbecic N, Schwarzacher S, Ploner M, Lassnigg A. et al. Significance of right bundle branch block in the diagnosis of myocardial ischemia in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg 2000;18:187-93.
  • 23. Pehkonen EJ, Honkonen EL, Makynen PJ, Kataja MJ, Tarkka MR. Conduction disturbances after different blood cardioplegia modes in coronary artery bypass grafting. Including comparison with an earlier patient series. Scand J Thorac Cardiovasc Surg 1996;30:149-55.
  • 24. Ueyama K, Jones JW, Ramchandani M, Beall AC, Thornby JI. Clinical variables influencing the appearance of right bundle branch block after cardiac surgery. Cardiovasc Surg 1997;5:574-8.
  • 25. Mosseri M, Meir G, Lotan C, Hasin Y, Applebaum A, Rosenheck S, et al. Coronary pathology predicts conduction disturbances after coronary artery bypass grafting. Ann Thorac Surg 1991;51:248-52.
There are 25 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research article
Authors

Oğuz Uğur 0000-0003-0433-4270

Mehmet Kalender This is me 0000-0002-8984-4028

Hayat Gökmengil This is me 0000-0002-7308-0887

Hakan Bingöl This is me 0000-0002-4084-2400

Publication Date February 2, 2018
Published in Issue Year 2018

Cite

APA Uğur, O., Kalender, M., Gökmengil, H., Bingöl, H. (2018). Does combined antegrade and selective coronary graft cardioplegia reduce conduction defects in right coronary artery occluded patients?. Journal of Surgery and Medicine, 2(1), 1-5. https://doi.org/10.28982/josam.368728
AMA Uğur O, Kalender M, Gökmengil H, Bingöl H. Does combined antegrade and selective coronary graft cardioplegia reduce conduction defects in right coronary artery occluded patients?. J Surg Med. April 2018;2(1):1-5. doi:10.28982/josam.368728
Chicago Uğur, Oğuz, Mehmet Kalender, Hayat Gökmengil, and Hakan Bingöl. “Does Combined Antegrade and Selective Coronary Graft Cardioplegia Reduce Conduction Defects in Right Coronary Artery Occluded Patients?”. Journal of Surgery and Medicine 2, no. 1 (April 2018): 1-5. https://doi.org/10.28982/josam.368728.
EndNote Uğur O, Kalender M, Gökmengil H, Bingöl H (April 1, 2018) Does combined antegrade and selective coronary graft cardioplegia reduce conduction defects in right coronary artery occluded patients?. Journal of Surgery and Medicine 2 1 1–5.
IEEE O. Uğur, M. Kalender, H. Gökmengil, and H. Bingöl, “Does combined antegrade and selective coronary graft cardioplegia reduce conduction defects in right coronary artery occluded patients?”, J Surg Med, vol. 2, no. 1, pp. 1–5, 2018, doi: 10.28982/josam.368728.
ISNAD Uğur, Oğuz et al. “Does Combined Antegrade and Selective Coronary Graft Cardioplegia Reduce Conduction Defects in Right Coronary Artery Occluded Patients?”. Journal of Surgery and Medicine 2/1 (April 2018), 1-5. https://doi.org/10.28982/josam.368728.
JAMA Uğur O, Kalender M, Gökmengil H, Bingöl H. Does combined antegrade and selective coronary graft cardioplegia reduce conduction defects in right coronary artery occluded patients?. J Surg Med. 2018;2:1–5.
MLA Uğur, Oğuz et al. “Does Combined Antegrade and Selective Coronary Graft Cardioplegia Reduce Conduction Defects in Right Coronary Artery Occluded Patients?”. Journal of Surgery and Medicine, vol. 2, no. 1, 2018, pp. 1-5, doi:10.28982/josam.368728.
Vancouver Uğur O, Kalender M, Gökmengil H, Bingöl H. Does combined antegrade and selective coronary graft cardioplegia reduce conduction defects in right coronary artery occluded patients?. J Surg Med. 2018;2(1):1-5.