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Koroner arter bypass cerrahisinde kullanılan damar grefti sayısının kısa dönem mortaliteye etkisi

Yıl 2020, Cilt: 45 Sayı: 4, 1402 - 1410, 27.12.2020
https://doi.org/10.17826/cumj.732731

Öz

Amaç: Çalışmada, özel bir hastanede koroner arter baypas greftleme (KABG) deneyiminin kısa dönem mortalite oranlarının paylaşılması ve damar grefti sayısına göre bölünen KABG sonrası klinik sonuçlarını etkileyen parametreleri değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışma, Türkiye'de 7 yıllık hasta takip süresi olan, uzun süreli gözlemsel bir klinik çalışmadır. 1 (n:608), 2-3 (n:1359) ve dört veya daha fazla (n:1060) greft olarak kullandığımız damar greftlerinin sayısına göre sonuçları ve kısa vadeli mortalitesi olan 3027 vakayı analiz ettik.
Bulgular: Kısa dönem mortalite tüm hastalarda 1,1% (36/3027) olarak bulundu. Erkek popülasyonu en fazla damar grefti olan grupta en yüksek idi ve kadınlara oranı yaptığımız damar greftleriyle korele idi. Ortalama aortik kros klemp süresi 36.6±17.2 dakika, baypas süresi 66.4±21 dakika idi. Revaskülarize edilen damar sayısı ortalama 3,17±0,9 (1-7) idi. Drenaj miktarı 419±286 ml idi. Yoğun bakım süresi 1,2±1,1 gün, hastanede kalma süresi 5,2±1,5 gün idi. Vasküler greft sayısına göre karşılaştırıldığında pozitif inotrop ajan, drenaj, kan temini, kros klemp ve pompa periyodu anlamlı farklılık gösterdi.
Sonuç: Damar grefti sayısı KABG ameliyatlarının klinik sonuçları ile pozitif ilişkiliydi. KABG sonuçlarımız başarılı olarak Türkiye ve uluslararası ameliyat ortalamalarının altında kısa dönem mortalite oranlarına ulaştı.

Kaynakça

  • 1. Songur MC, Ozyalcin S, Ozen A, Simsek E, Kervan U, Tasoglu I, et al. Does really previous stenting affect graft patency following CABG? A 5-year follow-up: The effect of PCI on graft survival. Heart Vessels. 2016 Apr;31(4):457-64. PubMed PMID: 25637043. Epub 2015/02/01. 2. Ozulku M, Aygun F. Effect of LIMA Harvesting Technique on Postoperative Drainage in Off-Pump CABG. Braz J Cardiovasc Surg. 2016 Apr;31(2):120-6. PubMed PMID: 27556310. Pubmed Central PMCID: PMC5062731. Epub 2016/08/25. 3. Guler A, Yildiz M, Karabay CY, Aung SM, Aykan AC, Karagoz A, et al. Case series of a rare complication of CABG. Fistula between the internal mammary artery and pulmonary vasculature. Herz. 2014 Feb;39(1):149-53. PubMed PMID: 23649318. Epub 2013/05/08. 4. Ozdemir S, Yener AU, Barutcu A, Tan YZ, Celik F. The assessment of septal wall motion in patients undergoing CABG by myocardial perfusion-gated SPECT. Nucl Med Commun. 2015 Jul;36(7):738-46. PubMed PMID: 25816362. Epub 2015/03/31. 5. Gumus F, Polat A, Yektas A, Totoz T, Bagci M, Erentug V, et al. Prolonged mechanical ventilation after CABG: risk factor analysis. J Cardiothorac Vasc Anesth. 2015 Feb;29(1):52-8. PubMed PMID: 25620139. Epub 2015/01/27. 6. Tatli E, Aktoz M, Cakar MA, Dogan E, Alkan M, Ozalp B. Survival of patients with well-developed collaterals undergoing CABG or medical treatment: an observational case-controlled study. Anadolu Kardiyol Derg. 2012 Mar;12(2):97-101. PubMed PMID: 22281787. Epub 2012/01/28. 7. Ak K, Isbir CS, Tetik S, Atalan N, Tekeli A, Aljodi M, et al. Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study. J Card Surg. 2009 Jul-Aug;24(4):404-10. PubMed PMID: 19583608. Epub 2009/07/09. 8. Nurozler F, Kutlu T, Kucuk G. Off-pump CABG in diabetic patients: does insulin dependency matter? Scand Cardiovasc J. 2007 Jan;41(1):39-43. PubMed PMID: 17365976. Epub 2007/03/17. 9. Alkan S, Topal E, Hanedan MO, Mataraci I. Assessment of healthy lifestyle behaviors after coronary artery bypass surgery. Turk Kardiyol Dern Ars. 2018 Apr;46(3):169-74. PubMed PMID: 29664422. Epub 2018/04/18. 10. Ozkan S, Ozdemir F, Ugur O, Demirtunc R, Balci AY, Kizilay M, et al. The effects of the metabolic syndrome on coronary artery bypass grafting surgery. Cardiovasc J Afr. 2017 Jan/Feb 23;28(1):48-53. PubMed PMID: 27701481. Pubmed Central PMCID: PMC5423427. Epub 2016/10/05. 11. Ucak M. Myelomeningocele closure by unilateral lumbar artery perforator flap: Experience with thirty-eight patients. Microsurgery. 2018 Oct;38(7):752-7. PubMed PMID: 29953654. Epub 2018/06/29. 12. Baser O, Burkan A, Baser E, Koselerli R, Ertugay E, Altinbas A. Coronary angiography utilization and costs for coronary artery bypass graft surgery patients in Turkey. Cardiol Ther. 2013 Dec;2(2):151-63. PubMed PMID: 25135393. Pubmed Central PMCID: PMC4107430. Epub 2014/08/20. 13. Coskun D, Aytac J, Aydinli A, Bayer A. Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey. J Hosp Infect. 2005 Jun;60(2):176-9. PubMed PMID: 15866018. Epub 2005/05/04. 14. Ovali C, Sahin A. Chronic Obstructive Pulmonary Disease and Off-Pump Coronary Surgery. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 2018 Aug 20;24(4):193-9. PubMed PMID: 29780070. Pubmed Central PMCID: PMC6102600. Epub 2018/05/22. eng. 15. Kalender M, Adademir T, Tasar M, Ecevit AN, Karaca OG, Salihi S, et al. Validation of EuroSCORE II risk model for coronary artery bypass surgery in high-risk patients. Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery. 2014 Sep;11(3):252-6. PubMed PMID: 26336431. Pubmed Central PMCID: PMC4283878. Epub 2015/09/04. eng. 16. Arnaz A, Sarioglu T, Yalcinbas Y, Erek E, Turkoz R, Oktay A, et al. Coronary artery bypass grafting in children. J Card Surg. 2018 Jan;33(1):29-34. PubMed PMID: 29315865. Epub 2018/01/10. eng. 17. Acarbas A. A Novel Prognostic Marker in Patients Undergoing Spinal Surgery: Prognostic Nutritional Index. J Neurol Surg A Cent Eur Neurosurg. 2019 Aug 29. PubMed PMID: 31466102. Epub 2019/08/30. 18. Onat A, Can Gn, HergenÁ Gl, K¸Á¸kdurmaz Z, U?ur M, Y¸ksel Hs. High absolute coronary disease risk among Turks: involvement of risk factors additional to conventional ones. Cardiology. 2010 04/16;115(4):297-306. 19. Toker M, Mataraci I, Caliskan A, Eren E. Seksen yaş ve üzerindeki hasta açık kalp cerrahisi ameliyatları ve sonuçları. Turk Gogus Kalp Damar. 2009;17(1):151-6. 20. Turna A. Asian perspective in surgery: thoracic surgery in Turkey. J Thorac Dis. 2016;8(Suppl 8):S601-S5. PubMed PMID: 27651934. eng. 21. Kervan Ü, Koc O, Ozatik M, Bayraktar G. Türkiye’deki Kalp ve Damar Cerrahisi Kliniklerinin Dagılımı ve Hizmetlerinin Niteligi. Turk Gogus Kalp Damar. 2011;19(1):483-9. 22. Simsek BK, Uygur F. Effects of Preoperative Laboratory Findings to the Risk of Re-exploration after Coronary Artery Bypass Graft Surgery. THE ULUTAS MEDICAL JOURNAL. 2019;5(2):142-8. 23. Bhakta D, Groh MR, Shen C, Pascuzzi RM, Groh WJ. Increased mortality with left ventricular systolic dysfunction and heart failure in adults with myotonic dystrophy type 1. Am Heart J. 2010 Dec;160(6):1137-41, 41 e1. PubMed PMID: 21146669. Epub 2010/12/15. 24. Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol. 1998 Sep;32(3):695-703. PubMed PMID: 9741514. Epub 1998/09/19. 25. Polat A. Mid-term results of coronary artery bypass graft surgery in patients 70 years of age or older. Turkish Journal of Thoracic and Cardiovascular Surgery. 2012;20(3):467-73.

The effect of the number of vessel grafts used in coronary artery bypass grafting surgery to short-term mortality

Yıl 2020, Cilt: 45 Sayı: 4, 1402 - 1410, 27.12.2020
https://doi.org/10.17826/cumj.732731

Öz

Purpose: The study aimed to share the short-term mortality rates of coronary artery bypass grafting (CABG) experience in a private hospital and to evaluate parameters affecting the clinical outputs following the CABG who were divided according to the number of vessel graft.
Materials and Methods: The study is a longitudinal-term observational clinical study, with a patient follow-up period of 7 years in Turkey. We analyzed 3027 cases with outcomes and short-term mortality according to the number of vessel grafts that we used as 1 (n:608), 2-3 (n:1359), and four or more (n:1060) grafts.
Results: The short-term mortality was found as 1.1% (36/3027) in all the patients. The male population was the highest in the group with the highest number of vascular grafts and its percentage to females was correlated with vessel grafts that we performed. Mean aortic cross-clamp time was 36.6±17.2 minutes, while bypass time was 66.4±21 minutes. The mean number of vessels revascularized was 3.17±0.9 (1-7). The amount of drainage was 419±286 ml. The period of intensive care was 1.2±1.1 days, while the hospital period was 5.2±1.5days. In comparison according to the number of vascular grafts, positive inotrope agent, drainage, blood supply, cross-clamp and pump period showed significant difference.
Conclusion: The number of vessel grafts was related to clinical outputs of CABG operations and Our CABG in the private hospital reached the short-term mortality rates that were below the averages of Turkey and international operations.

Kaynakça

  • 1. Songur MC, Ozyalcin S, Ozen A, Simsek E, Kervan U, Tasoglu I, et al. Does really previous stenting affect graft patency following CABG? A 5-year follow-up: The effect of PCI on graft survival. Heart Vessels. 2016 Apr;31(4):457-64. PubMed PMID: 25637043. Epub 2015/02/01. 2. Ozulku M, Aygun F. Effect of LIMA Harvesting Technique on Postoperative Drainage in Off-Pump CABG. Braz J Cardiovasc Surg. 2016 Apr;31(2):120-6. PubMed PMID: 27556310. Pubmed Central PMCID: PMC5062731. Epub 2016/08/25. 3. Guler A, Yildiz M, Karabay CY, Aung SM, Aykan AC, Karagoz A, et al. Case series of a rare complication of CABG. Fistula between the internal mammary artery and pulmonary vasculature. Herz. 2014 Feb;39(1):149-53. PubMed PMID: 23649318. Epub 2013/05/08. 4. Ozdemir S, Yener AU, Barutcu A, Tan YZ, Celik F. The assessment of septal wall motion in patients undergoing CABG by myocardial perfusion-gated SPECT. Nucl Med Commun. 2015 Jul;36(7):738-46. PubMed PMID: 25816362. Epub 2015/03/31. 5. Gumus F, Polat A, Yektas A, Totoz T, Bagci M, Erentug V, et al. Prolonged mechanical ventilation after CABG: risk factor analysis. J Cardiothorac Vasc Anesth. 2015 Feb;29(1):52-8. PubMed PMID: 25620139. Epub 2015/01/27. 6. Tatli E, Aktoz M, Cakar MA, Dogan E, Alkan M, Ozalp B. Survival of patients with well-developed collaterals undergoing CABG or medical treatment: an observational case-controlled study. Anadolu Kardiyol Derg. 2012 Mar;12(2):97-101. PubMed PMID: 22281787. Epub 2012/01/28. 7. Ak K, Isbir CS, Tetik S, Atalan N, Tekeli A, Aljodi M, et al. Thromboelastography-based transfusion algorithm reduces blood product use after elective CABG: a prospective randomized study. J Card Surg. 2009 Jul-Aug;24(4):404-10. PubMed PMID: 19583608. Epub 2009/07/09. 8. Nurozler F, Kutlu T, Kucuk G. Off-pump CABG in diabetic patients: does insulin dependency matter? Scand Cardiovasc J. 2007 Jan;41(1):39-43. PubMed PMID: 17365976. Epub 2007/03/17. 9. Alkan S, Topal E, Hanedan MO, Mataraci I. Assessment of healthy lifestyle behaviors after coronary artery bypass surgery. Turk Kardiyol Dern Ars. 2018 Apr;46(3):169-74. PubMed PMID: 29664422. Epub 2018/04/18. 10. Ozkan S, Ozdemir F, Ugur O, Demirtunc R, Balci AY, Kizilay M, et al. The effects of the metabolic syndrome on coronary artery bypass grafting surgery. Cardiovasc J Afr. 2017 Jan/Feb 23;28(1):48-53. PubMed PMID: 27701481. Pubmed Central PMCID: PMC5423427. Epub 2016/10/05. 11. Ucak M. Myelomeningocele closure by unilateral lumbar artery perforator flap: Experience with thirty-eight patients. Microsurgery. 2018 Oct;38(7):752-7. PubMed PMID: 29953654. Epub 2018/06/29. 12. Baser O, Burkan A, Baser E, Koselerli R, Ertugay E, Altinbas A. Coronary angiography utilization and costs for coronary artery bypass graft surgery patients in Turkey. Cardiol Ther. 2013 Dec;2(2):151-63. PubMed PMID: 25135393. Pubmed Central PMCID: PMC4107430. Epub 2014/08/20. 13. Coskun D, Aytac J, Aydinli A, Bayer A. Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey. J Hosp Infect. 2005 Jun;60(2):176-9. PubMed PMID: 15866018. Epub 2005/05/04. 14. Ovali C, Sahin A. Chronic Obstructive Pulmonary Disease and Off-Pump Coronary Surgery. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 2018 Aug 20;24(4):193-9. PubMed PMID: 29780070. Pubmed Central PMCID: PMC6102600. Epub 2018/05/22. eng. 15. Kalender M, Adademir T, Tasar M, Ecevit AN, Karaca OG, Salihi S, et al. Validation of EuroSCORE II risk model for coronary artery bypass surgery in high-risk patients. Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery. 2014 Sep;11(3):252-6. PubMed PMID: 26336431. Pubmed Central PMCID: PMC4283878. Epub 2015/09/04. eng. 16. Arnaz A, Sarioglu T, Yalcinbas Y, Erek E, Turkoz R, Oktay A, et al. Coronary artery bypass grafting in children. J Card Surg. 2018 Jan;33(1):29-34. PubMed PMID: 29315865. Epub 2018/01/10. eng. 17. Acarbas A. A Novel Prognostic Marker in Patients Undergoing Spinal Surgery: Prognostic Nutritional Index. J Neurol Surg A Cent Eur Neurosurg. 2019 Aug 29. PubMed PMID: 31466102. Epub 2019/08/30. 18. Onat A, Can Gn, HergenÁ Gl, K¸Á¸kdurmaz Z, U?ur M, Y¸ksel Hs. High absolute coronary disease risk among Turks: involvement of risk factors additional to conventional ones. Cardiology. 2010 04/16;115(4):297-306. 19. Toker M, Mataraci I, Caliskan A, Eren E. Seksen yaş ve üzerindeki hasta açık kalp cerrahisi ameliyatları ve sonuçları. Turk Gogus Kalp Damar. 2009;17(1):151-6. 20. Turna A. Asian perspective in surgery: thoracic surgery in Turkey. J Thorac Dis. 2016;8(Suppl 8):S601-S5. PubMed PMID: 27651934. eng. 21. Kervan Ü, Koc O, Ozatik M, Bayraktar G. Türkiye’deki Kalp ve Damar Cerrahisi Kliniklerinin Dagılımı ve Hizmetlerinin Niteligi. Turk Gogus Kalp Damar. 2011;19(1):483-9. 22. Simsek BK, Uygur F. Effects of Preoperative Laboratory Findings to the Risk of Re-exploration after Coronary Artery Bypass Graft Surgery. THE ULUTAS MEDICAL JOURNAL. 2019;5(2):142-8. 23. Bhakta D, Groh MR, Shen C, Pascuzzi RM, Groh WJ. Increased mortality with left ventricular systolic dysfunction and heart failure in adults with myotonic dystrophy type 1. Am Heart J. 2010 Dec;160(6):1137-41, 41 e1. PubMed PMID: 21146669. Epub 2010/12/15. 24. Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol. 1998 Sep;32(3):695-703. PubMed PMID: 9741514. Epub 1998/09/19. 25. Polat A. Mid-term results of coronary artery bypass graft surgery in patients 70 years of age or older. Turkish Journal of Thoracic and Cardiovascular Surgery. 2012;20(3):467-73.
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kalp ve Damar Cerrahisi
Bölüm Araştırma
Yazarlar

Omer Ulular 0000-0001-5617-4286

Yayımlanma Tarihi 27 Aralık 2020
Kabul Tarihi 19 Ağustos 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 45 Sayı: 4

Kaynak Göster

MLA Ulular, Omer. “The Effect of the Number of Vessel Grafts Used in Coronary Artery Bypass Grafting Surgery to Short-Term Mortality”. Cukurova Medical Journal, c. 45, sy. 4, 2020, ss. 1402-10, doi:10.17826/cumj.732731.