On-pump ve Off-pump Koroner Arter Bypass Greft Ameliyatı Yapılan Hastaların Cerrahi Sonuçlarının Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı on-pump ve off-pump koroner arter baypass greftleme (KABG) yapılan hastaların klinik sonuçlarını retrospektif olarak güncel literatür ışığında değerlendirmektir.

Gereç ve Yöntemler: Çalışmaya Ekim 2014 ile Ağustos 2016 tarihleri arasında KABG uygulanan ve postoperatif sinüs ritmi olan toplam 1672 hasta dahil edildi. KABG yanında ek bir işlem uygulanmış ve KABG dışında açık kalp ameliyatı geçiren hastalar çalışma dışı bırakıldı. Toplam 1672 hastadan 783'üne off-pump KABG ve 889'una on-pump KABG uygulandı.

Bulgular: Operasyonel verilerin karşılaştırılmasında, operasyon süresi (p<0.001), koroner arter baypass sayısı (p<0.001), posterior desenden artere yapılan sağ koroner arter baypasslarının sayısı (p<0.001) ve yaygın koroner arter hastalığı (p<0.001), off-pump KABG grubunda daha azdı ve istatistiksel olarak anlamlı bir farklılık vardı. Ameliyat sonrası verilerin karşılaştırılmasında, ameliyat sonrası atriyal fibrilasyon gelişimi (p<0.001), entübasyon süresi (p<0.001), yoğun bakımda kalma süresi (p<0.001), hastanede kalma süresi uzunluğu (p<0.001), reeksplorasyon (p=0.006), vazopressör ilaç kullanımı (p<0.001), pozitif inotropik ilaç kullanımı (p<0.001), toplam drenaj (p<0.001), kullanılan kan ve kan ürünü (p<0.001) ve mortalite oranı (p=0.001) off-pump KABG grubunda daha azdı ve gruplar arasında istatistiksel olarak anlamlı bir farklılık olduğu bulundu.

Sonuç: Bu çalışmada off-pump KABG’nin birçok avantajı olduğu saptanmıştır. Koroner arter hastalığı olan seçilmiş bir hasta grubunda çalışan kalpte KABG uygulanması hastaları kardiyopulmoner baypassın morbidite ve mortaliteye neden olan negatif etkilerinden korur.

Anahtar Kelimeler

• Off-pump,on-pump,koroner arter baypass,kardiyopulmoner baypass

Comparison of Surgical Results of Patients Undergoing On-pump and Off-pump Coronary Artery Bypass Grafting

Abstract

Aim: The aim of this study is to evaluate the clinical results of the patients undergoing off-pump and on-pump coronary artery bypass grafting (CABG) retrospectively in consideration of current literature.

Material and Methods: A total of 1672 patients undergoing CABG between October 2014 and August 2016 and having a postoperative sinus rhythm were enrolled in the study. Patients who underwent an additional procedure in addition to CABG and underwent open heart surgery except CABG were excluded from the study. Off-pump CABG was applied to 783 and on-pump CABG to 889 of 1672 patients.

Results: In comparison of operative data, duration of operation (p<0.001), number of bypasses to the coronary arteries (p<0.001), number of bypasses of the right coronary artery to the posterior descending artery (p<0.001), and diffuse coronary artery disease (p<0.001) were less in the off-pump CABG group and there was a statistically significant difference. In comparison of postoperative data, postoperative atrial fibrillation development (p<0.001), intubation time (p<0.001), intensive care unit stay (p<0.001), length of hospital stay (p<0.001), reexploration (p=0.006), vasopressor drug usage (p<0.001), positive inotropic drug usage (p<0.001), total drainage (p<0.001), blood and blood product used (p<0.001), and mortality rate (p=0.001) were less in the off-pump CABG group and statistically significant difference was found between groups.

Conclusion: In this study, we found that off-pump CABG has many advantages. In a selected group of patients having a coronary artery disease performing CABG in beating heart would avoid the patient from morbid and mortal negative effects of cardiopulmonary bypass.

Keywords

• Off-pump,on-pump,coronary artery bypass,cardiopulmonary bypass

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