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

Year 2018, Volume: 2 Issue: 1, 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

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

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

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