Comparison of Complications in Elderly Patients Undergoing Coronary Artery Bypass Surgery with or without Use of the Left Internal Thoracic Artery

Year 2014, Volume: 17 Issue: 2, 118 - 123, 01.02.2013

Mustafa Aldemir Devrim Eroğlu Fahri Adalı Mustafa Emmiler

https://doi.org/10.4274/khj.55707

Abstract

Introduction: This study aimed to compare postoperative complications in elderly patients who underwent coronary artery bypass grafting surgery with or without use of the left internal thoracic artery.Patients and Methods: In this retrospective clinical study, 40 patients over 75 years old undergoing coronary artery bypass grafting surgery between September 2011 and December 2013 in our clinic were included. Twenty of the patients underwent coronary surgery with LITA and the other 20 patients underwent without LITA. We compared the two groups on the basis of postoperative mechanical complications.Results: Postoperative pneumothorax was seen in 3 patients (15%, p=0.03) who had undergone coronary artery surgery with LITA. Sternal dehiscence was seen in one patient (5%, p=0.047) and sternal infection was seen in one other patient (5%, p=0.047) in whom LITA was used. None of these complications were seen in patients in whom LITA was not used.Conclusion: Postoperative complications such as pneumothorax, sternal dehiscence and sternal infection were more common in elderly patients in whom LITA was used. However, in consideration of the important superiorities of LITA, this graft cannot be easily abandoned. In conclusion, if the required measures are taken in the elderly without diabetes mellitus, osteoporosis, pre-operative pulmonary disease which would negatively affect the post-operative prognosis, complications related with LITA grafting would not be as serious as to refrain from using this graft in elderly patients.

Keywords

Left internal thoracic artery, elderly; coronary artery by-pass

Sol İnternal Torasik Arter Kullanılarak ve Kullanılmayarak Koroner Arter Bypass Cerrahisine Giden Yaşlı Hastalarda Komplikasyonların Karşılaştırılması

Abstract

Giriş: Bu çalışma ile koroner arter bypass cerrahisine giden yaşlı hastalarda, sol internal torasik arter grefti kullanılanlar ile kulanılmayanların postoperatif komplikasyonlar açısından karşılaştırılması amaçlanmıştır.Hastalar ve Yöntem: Kliniğimizde Eylül 2011 ile Aralık 2013 tarihleri arasında koroner bypass cerrahisine giden 75 yaş üstü hastalardan sol internal torsik arter kulanılan 20 hasta ve kullanılmayan 20 hasta retrospektif olarak değerlendirilmiştir. Toplam 40 hasta sol internal torasik arter grefti hazırlanan grup 1 ve hazırlanmayan grup 2 olmak üzere postoperatif mekanik komplikasyonlar açısından karşılaştırılmıştır.Bulgular: Postoperatif pnömotorax, LİTA kullanılan grupta 3 hastada (%15 p=0,03), sternal dehiscence ve sternal enfeksiyon ise yine LİTA kullanılan grupta birer hastada (%5, p=0,047) görülürken LİTA kullanılmayan grupta bu komplikasyonlar hiçbir hastada tesbit edilmedi.Sonuç: Sol internal torasik arter grefti hazırlanan yaşlı hastalarda pnömotorax, sternal dehiscence ve sternal enfeksiyon gibi postoperatif komplikasyonlar daha yaygındı. Ancak LİTA grefti çok önemli üstünlükleri düşünüldüğünde kolay vazgeçilebilecek bir greft değildir. Sonuç olarak, diabetes mellitus, osteoporozis, preoperatif pulmoner hastalık gibi postoperatif dönemde prognozu olumsuz etkileyebilecek sorunları olmayan yaşlı hastalarda gerekli önlemler alındığında, LİTA greft hazırlanmasına bağlı komplikasyonların, yaşlılarda bu greftin kullanımının kısıtlanmasını gerektirecek düzeyde olmadığını düşünmekteyiz.

Keywords

Sol internal torasik arter, yaşlı; koroner by-pass

References

• Loop FD, Lytle BW, Cosgrove DM, Goormastic M, Taylor PC, Golding LA, et al. Coronary artery bypass graft surgery in the elderly. Indications and outcome. Cleve Clin J Med 1988;55:23-34.
• Loran DB, Zwischenberger JB. Thoracic surgery in the elderly. J Am Coll Surg 2004;199:773-84.
• Kay EB, Naraghipour H, Beg RA, DeManey M, Tambe A, Zimmerman HA. Internal mammary artery bypass graft- long term patency rate and follow-up. Ann Thorac Surg 1974;18:269-79.
• Ricci M, Karamanoukian HL, Abraham R, Von Fricken K, D’Ancona G, Choi S. et al. Stroke in octogenarians undergoing coronary artery surgery with and without cardiopulmonary bypass. Ann Thorac Surg 2000;69:1471- 5.
• Moshkovitz Y, Paz Y, Shabtai E, Cotter G, Amir G, Smolinsky AK, et al. Predictors of early and overall outcome in coronary artery bypass without cardiopulmonary bypass. Eur J Cardiothorac Surg 1997;12:31-9.
• Wilson MF, Baig MK, Ashraf H. Quality of life in octagenarians after coronary artery bypass grafting. Am J Cardiol 2005;95:761-4.
• Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long- term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 1985;89:248-58.
• Gardner TJ, Greene PS, Rykiel MF, Baumgartner WA, Cameron DE, Casale AS, et al. Routine use of the left internal mammary artery graft in the elderly. Ann Thorac Surg 1990;49:188-94.
• Edwards FH, Clark RE, Schwartz M. Impact of the internal mammary artery conduits on operative mortality in coronary revascularization. Ann Thorac Surg 1994;57:27-32.
• Cohn L. Use of the internal mammary artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery. Circulation 2001;103:483-4.
• Hurlbut D, Myers ML, Lefcoe M, Goldbach M. Pleuropulmonary morbidity: internal thoracic artery versus saphenous vein graft. Ann Thorac Surg 1990;50:959-64.
• Areno JP, McCartney JP, Eggerstedt J, Grafton W, George RB. Persistent pleural effusions following coronary bypass surgery. Chest 1998;114:311-4.
• Kollef MH. Symptomatic pleural effusion after coronary artery revascularization: unsuspected pleural injury from internal mammary artery resection. South Med J 1993;86:585-8.
• Berrizbeitia LD, Tessler S, Jacobowitz IJ, Kaplan P, BudzilowicL L, Cunningham JN. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics. Chest 1989;96:873-6.
• Guizilini S, Gomes WJ, Faresin SM, Bolzan DW, Buffolo E, Carvalho AC et al. Influence of pleurotomy on pulmonary function after off-pump coronary artery bypass grafting. Ann Thorac Surg 200;84:817-22.
• Molina JE, Lew RS, Hyland KJ Postoperative sternal dehiscence in obese patients: incidence and prevention. Ann Thorac Surg 2004;78:912-7.
• Baskett RJ, MacDougall CE, Ross DB. Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg.1999;67:462-5.
• Zhang X, Wu Z, Peng X, Wu A, Yue Y, Martin J et al. Prognosis of diabetic patients undergoing coronary artery bypass surgery compared with nondiabetics: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 2011;25:288-98.
• Filsoufi F, Rahmanian PB, Castillo JG, Mechanick JI, Sharma SK, Adams DH. Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2007;6:753-8.
• Filsoufi F, Castillo JG, Rahmanian PB, Broumand SR, Silvay G, Carpentier A, et al. Epidemiology of deep sternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth 2009;23:488-94.
• Cosgrove DM, Loop FD, Lytle BW, Goormastic M, Stewart RW, Gill CC, et al. Does mammary artery grafting increase surgical risk? Circulation 1985;72:170-4.
• Horneffer PJ, Gardner TJ, Manolio TA, Hoff SJ, Rykiel MF, Pearson TA, et al. The effects of age on outcome after coronary bypass surgery. Circulation 1987;76;6-12.