Effects of Left Internal Thoracic Artery Graft Use on Coronary Artery Bypass Grafting Mortality and Morbidity in Octogenarians

Year 2018, Volume: 21 Issue: 2, 135 - 142, 19.08.2018

Mehmet Kalender , Serpil Taş Mehmet Taşar Taylan Adademir Hasan Sunar

Abstract

Introduction:
Atherosclerotic
heart disease is the leading cause of death in developed countries. In our
country, the numbers are slightly lower, but increase each year. In 2008, the
number of cases was 10.410 (12.03%) of all deaths among people aged 75 and
over. The proportion of octogenarians undergoing cardiac surgery is increasing,
although this high risk population has many unknown issues to decrease
mortality and morbidity.The aim of this study was to understand and compare the
role of left internal thoracic artery (LITA) versus saphenous vein (SVG) to
left anterior descending artery (LAD) grafting on early- and mid-term results.

Patients
and Methods: A retrospective analysis was conducted on 105 consecutive
patients who were 80 years of age or older and who underwent isolated coronary
artery bypass grafting (CABG) between January 2000 and January 2010. Patients
with saphenous venous graft only (SVG; n: 27) were compared with those
receiving arterial (LITA; n: 78) and saphenous venous grafts. Mean follow-up
was 42.95 ± 23.36 months.

Results: There was
no significant difference in mortality and morbidity between the groups (p>
0.05). A longer duration of aortic cross-clamping was found to be associated
with postoperative renal failure in patients with saphenous venous grafts
(p< 0.05). There was no statistically significant difference in 8-year
survival rates between the groups (p> 0.05).

Conclusion: In conclusion,
octogenarians should receive complete revascularization with short aortic
cross-clamp time. We could not demonstrate the importance of graft choice for
long-term functional outcome and survival as a prognostic factor in this age
group who underwent coronary artery bypass surgery. 

Keywords

Octogenarian, coronary artery bypass grafting, left internal thoracic artery, saphenous vein graft

Seksenli Yaş Grubunda Koroner Baypasta Sol İnternal Torasik Arter Grefti Kullanımının Mortalite ve Morbiditeye Etkisi

Abstract

Giriş: Aterosklerotik kalp hastalığı gelişmiş ülkelerde en
önemli ölüm nedenidir. Ülkemizde de giderek artan bir yüzdeyle mortalitede üst
sıralarda bulunmaktadır. 2008 yılında 75 yaş üstü nüfusun %12.03’ünde ölüm
nedeninin iskemik kalp hastalığı olduğu saptanmıştır. Kalp cerrahisinde giderek
artan bir yüzdeye sahip olan seksenli yaş grubunda operatif mortalite ve
morbiditeyi azaltmak için araştırılması gereken pek çok başlık mevcuttur.
Çalışmamızda koroner arter baypas greft (CABG) yapılan seksenli yaş grubu
hastalarda sol ön inen koroner arter baypasında safen ven (SVG) veya sol
internaltorasik arter grefti (LITA) seçiminin erken ve orta dönem mortalite
açısından rolünü araştırdık.

Hastalar ve Yöntem: Ocak 2000-Ocak 2010 yılları
arasında izole CABG operasyonu uygulanmış seksenli yaş grubunda 105 hasta
çalışmaya dahil edilerek retrospektif olarak incelendi. LITA kullanılan
[LITAgrubu (n: 78)] ve kullanılmayan [SVG grubu (n: 27)] hastalar kıyaslandı.
Ortalama takip süresi 42.95 ± 23.36 aydı.

Bulgular: Mortalite ve morbidite açısından her iki grup arasında
istatistiksel anlamlı fark izlenmedi (p> 0.05). SVG grubunda uzun aortik
kros klemp süresi ile postoperatif renal yetmezlik arasında ilişki olduğu
bulundu (p< 0.05). Sekiz yıllık takipte hayatta kalım açısından her iki grup
arasında istatistiksel fark yoktu (p> 0.05).

Sonuç: Seksenli yaş grubu
hastalarda beklenen kısa yaşam sürelerine rağmen komplet revaskülarizasyon ve
kısa aortik kros klemp süresi ile CABG başarıyla uygulanabilir. Bizim
çalışmamızda LITA kullanımı mortaliteye etkili bulunmamıştır.

Keywords

Seksenli yaş grubu (oktogenaryan), koroner arter baypas greftleme, sol internal torasic arter, safen ven

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