Off-Pump Coronary Artery Bypass Grafting: Edirne Experience

Yıl 2006, Cilt: 2006 Sayı: 1, 4 - 8, 01.01.2006

Enver Duran Hasan Sunar Turan Ege Suat Canbaz Mustafa Çıkırıkçıoğlu Mustafa Çıkırıkçıoğlu Cavidan Arar Ümit Halıcı Ümit Halıcı Habib Çakır

Öz

Objectives: The aim of this study was to evaluate the mid-term results of off-pump coronary artery bypass surgery. Study Design: The study included 60 patients (45 males, 15 females; mean age 62±9.1 years; range 42 to 78 years) who underwent off-pump coronary artery bypass operation in our clinic between 1999 and 2003. All operations were performed by the same surgeon. Data were collected by review of operation and intensive care unit records. Final status of the patients were inquired by telephone calls. The mean follow-up period was 23.3±14.9 months (range 1.1 to 59.4 months). Results: Perioperative myocardial infarction was not detected in any patient. No postoperative mortality occurred in the early period. Late mortality was found in four patients (6.7%). Five-year survival was 66% using the Kaplan-Meier survival analysis. Conclusion: Our results show that off-pump coronary artery bypass can be performed with safety and comfort. Turkish Başlık: Off-Pump Koroner Baypas Sonuçlarının Değerlendirilmesi: Edirne Deneyimi Anahtar Kelimeler: Kardiyopulmoner baypas/yöntem; koroner arter baypas/yöntem; sağkalım oranı Amaç: Çalışan kalpte koroner baypas (off-pump) tekniğiyle ameliyat edilen olguların orta dönem sonuçları değerlendirildi. Çalışma Planı: Bu retrospektif çalışmaya 1999-2003 yılları arasında off-pump baypas yapılan 60 olgu (45 erkek, 15 kadın; ort. yaş 62±9.1; dağılım 42-78) alındı. Ameliyatlar aynı cerrah tarafından gerçekleştirildi. Hasta verileri ameliyat ve yoğun bakım kayıtları taranarak elde edildi. Dosyalardaki adres veya telefon numaralarından hastalara ulaşılarak son durumları öğrenildi. Ortalama takip süresi 23.3±14.9 ay (dağılım 1.1-59.4 ay) idi. Bulgular: Hiçbir hastada ameliyat anında miyokard infarktüsü görülmedi. Ameliyat sonrası erken dönemde hiçbir hasta kaybedilmedi, geç dönem mortalite dört hastada (%6.7) görüldü. Beş yıllık sağkalım Kaplan-Meier yaşam analizine göre %66 bulundu. Sonuç: Bulgularımız, çalışan kalpte koroner baypas ameliyatının güvenli ve rahat uygulanabilir bir teknik olduğu yönündedir.

Anahtar Kelimeler

Cardiopulmonary bypass/methods; coronary artery bypass/methods; survival rate.

Off-Pump Koroner Baypas Sonuçlar›n›n De¤erlendirilmesi: Edirne Deneyimi

Öz

Anahtar Kelimeler

Kardiyopulmoner baypas/yöntem, koroner arter baypas/yöntem, sağkalım oranı

Kaynakça

• Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion require- ments, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;125:797-808.
• Kalp damar cerrahisi [Ameliyat kayıtları]. Ankara: Gülhane Askeri Tıp Akademisi Arşivi; 1993.
• Duran E. Çalışan kalpte koroner revaskülarizasyon. In: Duran E, editör. Kalp ve Damar Cerrahisi. 1. Bas- kı. İstanbul: Çapa Tıp Kitabevi; 2004; s. 1447-57.
• Saba D, Gören S, Tekin BH, Kan-Aytaç İİ, Şenkaya I, Ercan A ve ark. Çalışan kalpte koroner bypass sırasında hemodinamiye pozisyon, iskemi ve reper- füzyonun etkileri. Türk Göğüs Kalp Damar Cer Derg 2003;11:26-31.
• Rahman A, Burma O, Uysal A, Bayar MK, Beştaş A, Üstündağ B. Kardiyopulmoner bypass ve çalışan kalp teknikleri ile yapılan ameliyatların kardiyak performansa etkisi. Türk Göğüs Kalp Damar Cer Derg 2001;9:68-73.
• Kirali K, Kocak T, Guzelmeric F, Goksedef D, Kayalar N, Yakut C. Off-pump awake coronary revascularization using bilateral internal thoracic arteries. Ann Thorac Surg 2004;78:1598-602.
• Tasdemir O, Vural KM, Karagoz H, Bayazit K. Coronary artery bypass grafting on the beating heart without the use of extracorporeal circulation: review of 2052 cases. J Thorac Cardiovasc Surg 1998;116:68- 73.
• Akpinar B, Guden M, Sanisoglu I, Sagbas E, Caynak B, Bayramoglu Z, et al. Does off-pump coronary artery bypass surgery reduce mortality in high risk patients? Heart Surg Forum 2001;4:231-6.
• Eryilmaz S, Corapcioglu T, Eren NT, Yazicioglu L, Kaya K, Akalin H. Off-pump coronary artery bypass surgery in the left ventricular dysfunction. Eur J Cardiothorac Surg 2002;21:36-40.
• Naseri E, Sevinc M. Off-Pump Coronary Bypass through Very Limited Sternotomy. Heart Surg Forum 2003;6:E63-7.
• Cimen S, Ozkul V, Ketenci B, Yurtseven N, Gunay R, Ketenci B, et al. Daily comparison of respiratory functions between on-pump and off-pump patients undergoing CABG. Eur J Cardiothorac Surg 2003; 23:589-94.
• Köksal C, Sarıkaya S, Özcan V, Zengin M, Meydan B, Helvacı A ve ark. SSK Süreyyapaşa Hastanesi’nde açık kalp cerrahisi: ilk 100 vaka. Türk Göğüs Kalp Damar Cer Derg 2002;10:264-6.
• Akbas H, Erdal AC, Demiralp E, Alp M. Effects of coronary artery bypass grafting on cellular immuni- ty with or without cardiopulmonary bypass: changes in lymphocytes subsets. Cardiovasc Surg 2002;10:586-9.
• Posacioglu H, Apaydin A, Calkavur T, Uc H. Myocardial protection during coronary artery bypass surgery while off-pump. Anadolu Kardiyol Derg 2001;1:197-201.
• Kutay V, Ekim H, Kırali K, Güler M, Yakut C. Van ve Çevre İllerde Yaşayan Koroner Arter Hastalarının Profili ve CABG Sonuçları. Türk Göğüs Kalp Damar Cer Derg 2003;11:1-4.
• Yasım A, Aşık R. Yeni bir açık kalp cerrahisi merkezi: Kayseri Devlet Hastanesi’nin 3 yıllık deneyimi. Türk Göğüs Kalp Damar Cer Derg 2004; 12:22-5.
• Kazaz H, Üstünsoy H, Celkan A, Koçoğlu H, Hayta R. Off-pump koroner arter cerrahisinde hemodi- namik değişimlerin transözofegeal ekokardiyografi ile izlenmesi. Türk Göğüs Kalp Damar Cer Derg 2004;12:86-9.
• Mariani MA, D’Alfonso A, Grandjean JG. Total arte- rial off-pump coronary surgery: time to change our habits? Ann Thorac Surg 2004;78:1591-7.
• Dybdahl B, Wahba A, Haaverstad R, Kirkeby- Garstad I, Kierulf P, Espevik T, et al. On-pump ver- sus off-pump coronary artery bypass grafting: more heat-shock protein 70 is released after on-pump surgery. Eur J Cardiothorac Surg 2004;25:985-92.
• Srinivasan AK, Grayson AD, Fabri BM. On-pump versus off-pump coronary artery bypass grafting in diabetic patients: a propensity score analysis. Ann Thorac Surg 2004;78:1604-9.
• Vander Salm TJ, Kip KE, Jones RH, Schaff HV, Shemin RJ, Aldea GS, et al. What constitutes optimal surgical revascularization? Answers from the Bypass Angioplasty Revascularization Investigation (BARI). J Am Coll Cardiol 2002;39:565-72.
• van den Brand MJ, Rensing BJ, Morel MA, Foley DP, de Valk V, Breeman A, et al.The effect of complete- ness of revascularization on event-free survival at one year in the ARTS trial. J Am Coll Cardiol 2002; 39:559-64.
• Kilo J, Baumer H, Czerny M, Hiesmayr MJ, Ploner M, Wolner E, et al. Target vessel revascularization without cardiopulmonary bypass in elderly high- risk patients. Ann Thorac Surg 2001;71:537-42.
• Moon MR, Sundt TM 3rd, Pasque MK, Barner HB, Gay WA Jr, Damiano RJ Jr. Influence of internal mammary artery grafting and completeness of revascularization on long-term outcome in octoge- narians. Ann Thorac Surg 2001;72:2003-7.
• Wehlin L, Vedin J, Vaage J, Lundahl J. Activation of complement and leukocyte receptors during on- and off pump coronary artery bypass surgery. Eur J Cardiothorac Surg 2004;25:35-42.
• Nakamura Y, Nakano K, Nakatani H, Gomi A, Sato A, Sugimoto K. Hospital and mid-term outcomes in elderly patients under-going off-pump coronary artery bypass grafting--comparison with younger patients. Circ J 2004;68:1184-8.
• Athanasiou T, Aziz O, Mangoush O, Al-Ruzzeh S, Nair S, Malinovski V, et al. Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited. Eur J Cardiothorac Surg 2004;26:701-10.