Experience of Coronary Artey Bypass Grafting Surgery for Advanced Age Patients

Year 2012, Volume: 3 Issue: 10, 9 - 16, 03.03.2015

Hasan Umcu Mehmet Acıpayam Tolga Badak Serkan Ketenciler Habib Çakır İbrahim Özsöyler

Abstract

Aim: Number of the advanced age patients
undergoing coronary artery bypass surgery (CABG)
are increasing. Perioperative and postoperative
morbidity and mortality rates remain high for
advanced age patients when this group are
compared to the younger patients group. In this
article, we aimmed that to evaluate retrospectively
early period results of operation and demographic
datas of the 80 years old and over patients who
undergone isolated CABG with cardiopulmonary
bypass (CPB).
Patients and Methods: Twenty two patients that
80 years old and over underwent elective isolated
CABG operation with CPB in Cardiovascular
Surgery Clinic of Adana Numune Resarch and
Training Hospital between January 2004 and May
2012. The demographic datas of the patients and
perioperative and postoperative parameters were
evaluated.
Results: Mean age of patients was 82.3±3.9 (80-
97), 17 of them were male and 5 female. 54.5 % of
the patients were smokers, 22.7 % of them diabetes
mellitus, 40.9 % of them hipertension and 13.6 %
of them chronic obstructive pulmonary disease.
22.7 % of patients had one vessel disease, 18.2 %
of them had two vessels disease and 59.1 % of them
had three vessels disease. Mean aortic cross clemp
time was 38.8±15.2 minutes, total cardiopulmonary
bypass time 78.5±35 minutes and ratio of internal
thoracic artery usage was 63.6 %. Inotropic drugs
usage needed for 72.7 % of patients when weaning
from cardiopulmonary bypass. Intraaortic baloon
pump was performed for one patient (4.5 %). In
postoperative period, delirium was seen 13.6 % of
patients (3 cases), stroke was 4.5 % (1 case), atrial
fibrillation was 13.6 % (3 cases) and wound
infection was 4.5 % (1 case). Two patients were
reoperated for drainage in postoperative early
period and mortality was not seen.
Conclusion: Coronary bypass surgery for advanced
age patients can be applied successfully with
acceptable hospital mortality rate in spite of
increase of postoperative complication rate,
duration of hospitalization and morbidity. 

Keywords

Coronary Artery Bypass Surgery, Advanced Age, Risk Factors

İLERİ YAŞLI HASTALARDA KORONER BYPASS DENEYİMİ

Abstract

Amaç: İleri yaş hastalarda koroner arter bypass cerrahisi (CABG) giderek artmaktadır. Daha genç hasta grubu ile karşılaştırıldığında bu grup hastalarda perioperatif ve postoperatif morbidite ve mortalite yüksek seyretmektedir. Bu yazımızda, kliniğimizde kardiyopulmoner bypas (CPB) altında izole CABG operasyonu yapılan 80 yaş ve üzerindeki hastaların demografik verileri ve operasyonun erken dönem sonuçlarını retrospektif olarak değerlendirmeyi amaçladık. Hastalar ve Yöntem: Ocak 2004 - Mayıs 2012 yılları arasında Adana Numune Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahi Kliniğinde elektif şartlarda 80 yaş ve üzerinde 22 hastaya CPB altında izole CABG operasyonu uygulanmıştır. Hastaların demografik verileri ile perioperatif ve postoperatif parametreleri değerlendirildi.Bulgular: Hastaların 17’si erkek, 5’i kadın, ortalama yaş 82.3±3.9 (80-97) idi. Hastaların%54.5’i sigara içmekte olup, %22.7’sinde diyabetes mellitus, %40.9’unda hipertansiyon, %13.6’sında kronik obstrüktif akciğer hastalığı mevcuttu. Hastaların %22.7'sinde tek damar, %18.2'sinde iki damar, %59.1'inde üç damar lezyonu mevcuttu.Ortalama aortik kross klemp 38.8±15.2 dakika, total CPB zamanı 78.5±35 dakika, sol internal mamariyal arter kullanım oranı %63.6 idi. CPB’dan ayrılma esnasında olguların %72.7’sinde inotropik destek gereksinimi oldu. Bir hastaya (%4.5) intraaortik balon pompası (İABP) uygulandı. Postoperatif dönemde olguların %13.6’sında (3 olgu) deliryum, %4.5’inde (1 olgu) stroke, %13.6’sında (3 olgu) atriyal fibrilasyon, %4.5’inde (1 olgu) yara yeri enfeksiyonu gelişmişti. İki hasta postoperatif erken dönemde kanama nedeniyle revizyona alınmış olup, mortalite görülmemiştir. Sonuç: İleri yaş grubundaki hastalarda postoperatif komplikasyon oranı, hastane yatış süresi, morbiditenin artmasına karşın bu hastalarda da koroner bypass cerrahisi kabul edilebilir hastane mortalitesi ile başarıyla uygulanabilmektedir..

Keywords

Koroner Arter Bypass Cerrahisi, İleri Yaş, Risk Faktörleri

References

• Salomaon NW, Page US, Bigelovv JC, Krause AH, Okies JE, Mezdorg MT. Coronary artery bypass grafting in elderly patients: Comparative results in a consecutive series of 469 patients older than 75 years. J Thorac Cardiovasc Surg 1991; 101: 209-18.
• Galbut DL, Traad EA, Dorman MJ, DeVVitt PL, Larsen PB, Kurlansky PA, Carrillo MG. Coronary artery bypass grafting in the elderly: Single versus bilateral internal mammary artery grafts. J Thorac Cardiovasc Surg 1993; 106: 128-36.
• He GW, Acuff TE, Ryan WH, Brovvman RT, Douthit MB, Mack MJ. Determinants of operative mortality in elderly patients undergoing coronary artery bypass grafting: Emphasis on the influence of internal mammary artery grafting on mortality and morbidity. J Thorac Cardiovasc Surg 1994; 108: 73-81.
• Albes JM, Schistek R, Baier R, Unger A, Hangier H, Unger F. Earlv and late results follovving coronary bypass surgery beyond the age of 75 years. Thorac Cardiovasc Surgeon 1991; 39: 289-93.
• Edmunds LH Jr, Stephenson LW, Edie RN, Ratcliffe MB. Open-heart surgery in octogenerians. N Engl J Med 1988; 319: 131-6.
• Hancock EW. Aortic stenosis, angina pectoris, and coronary artery disease. Am Heart J 1977; 93: 382-93.
• Curtis JJ, Walls JT, Boley TM, Chmaz RA, Demmy TL, Salam N. Coronary revascularisation in the elderly: Determinations of operative mortality. Ann Thorac Surg 1994; 58: 1069-72.
• Peterson ED, Cowper PA, Jollis JG, et al. Outcomes of coronary artery bypass graft surgery in 24461 patients aged 80 years or older. Circulation 1995; 92: 11-85-91.
• Kirsch M, Guesnier L, LeBesnerais, et al. Cardiac operations in octogenarians: Perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 1998; : 60-67.
• Yorgancıoğlu C, Tezcaner T, Tokmakoğlu H, et al. İleri yaş grubunda koroner bypass deneyimi. GKDC Dergisi 1999; 7: 30-35.
• Emiroğulları ÖN, Ceyran H, Tezcaner T, et al. 65 yaş ve üzerindeki hastalarda koroner arter cerrahisi. T Klin Kapl-Damar Cerrahisi 2000, 1: 51-54.
• Morris RJ, Strong MD, Grunewald KE, et al. Internal thoracic artery for coronary artery grafting in octogenarians. Ann Thorac Surg 1996; 62: 16-22.
• Akins CW, Daggett WM, Vlahakes GJ, et al. Cardiac operations in patients 80 years old and older. Ann Thorac Surg 1997; 64: 606-615.
• McGrath LB, Adkins MS, Chen C, et al. Actuarial survival and other events following valve surgery in octogenarians: comparison with an age-sex and race-matched population. Eur J Cardiothorac Surg 1991; 5: 319-325.
• Tsai TP, Chaux A, Matloff |M, Kass RM, Gray RJ, DeRobertis MA, Khan SS: Ten Year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg 1994; 58:445-451.
• Smith JM, Rath R, 11 İdman UJ, Schıeiber JT: Coronary artery bypass grafting in the elderly: Changing trends and results. J Cardiovasc Surg 1992: 33:468-471.
• Rose DM, Gelbtish J, Jacobovvit/ II, et al: Analysis of morbidity and mortality in patients 70 years and över undergoing isolated coronary artery bypass surgery. Am Heart J 1985; 110: 341-346.
• Utley JR, Leyland SA. Coronary artery bypass grafting in the octogenerian. J Thorac Cardiovasc Surg 1991; 101: 866-870.
• Akins CW, Daggett WM, Vlahakes GJ, et al. Cardiac operations in patients 80 years old and older. Ann Thorac Surg 1997; 64: 606-615.
• Saldanha RF, Raman J, Esmore DS, Spratt PM, Farnsorts AE, Chang VP, Shan MX. Myocardial revascularisation in patients över seventy five years. J Cardiovasc Surg ; 29: 624-628
• Tablo 1: Olguların demografik verileri VKI: Vücut kitle indeksi; DM: Diyabetes mellitus; EF; Ejeksiyon fraksiyonu; HT: Hipertansiyon; KOAH: Kronik obstrüktif akciğer hastalığı; LMCA: Sol ana koroner arter; LDL: Düşük dansiteli lipoprotein; PTCA: Perkütan transluminal koroner anjioplast Minimum-Maksimum Yaş 3±3.9 97 VKI 5±3.5 35 LDL (mg/dl) ±36.3 185 EF (%) 7±8.2 68 Euroscore 4±1.4 9 Evet Yüzde (%) Cinsiyet Erkek 3 DM 7 HT 9 KOAH 6 Sigara 5 Obesite 8 Hiperlipidemi 5 Düşük EF (<%30) 6 PTCA 2 LMCA hastalığı 6 Tek damar hastalığı 7 İki damar hastalığı 2 Üç damar hastalığı 1