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Atan kalpte koroner arter bypass cerrahisi sonuçlarımız

Yıl 2004, Cilt: 1 Sayı: 4, 17 - 20, 01.08.2004

Öz

Amaç: Kalp cerrahisinde atan kalpte koroner arter bypass KABC tekniği öncelikle yüksek riskli hastalarda olmak üzere günümüzde yaygın olarak kullanılmaktadır. Bu çalışmada koroner arter hastalığı nedeniyle kliniğimizde Euroscore > 5 olan hastalarda çalışan kalpte KABC tekniği ile ameliyat ettiğimiz olguların sonuçlarını sunmayı amaçladık. Gereç ve Yöntem: Kliniğimizde Nisan 2002-Ocak 2005 tarihleri arasındaki dönemde 86 atan kalpte KABC ameliyatı yapıldı. Tüm olguların yaş ortalaması 61.5 ± 8.9 yıl ve %89.64’ü erkek idi. Preoperatif değerlendirilmelerinde olguların risk faktörleri; sigara içimi 23 olgu %27.90 , diyabet 19 olgu %23.25 , hipertansiyon 34 olgu %40.69 , kronik obstrüktif akciğer hastalığı 6 olgu %6.97 ile sıralanmaktaydı. Bulgular: Olguların sol ventrikül ejeksiyon fraksiyonu % 34.2 ± 9.1 ve Euroscore değerleri 9.7 ± 3.1 bulundu. Ortalama distal anastomoz 1.99 ± 0.6 olarak gerçekleştirildi. Ortalama yoğun bakım kalış süresi 19 ± 5.2 saat , hastane kalış süresi 7.5 ± 1.5 gün idi. Sekiz olguda %9.19 intraaortik balon pompası kullanıldı. Beş olguya %5.74 atan kalpte KABC ve koroner endarterektomi yapıldı. Hastane mortalitesi 3 hastada % 3.4 görüldü. Sonuç: Atan kalpte KABC tekniğinin yüksek riskli hastalarda kabul edilebilir mortalite ve morbiditeyle uygulanabileceği kanaatindeyiz

Kaynakça

  • Cleveland JC Jr, Shroyer AL, Chen AY, Peterson E, Grover FL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001; 72: 1282–1289.
  • Plomondon ME, Cleveland JC Jr, Ludwig ST, et al. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg 2001; 72: 114– 119.
  • Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 2002; 359: 1194–1199.
  • Magee MJ, Jablonski KA, Stamou SC, et al. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients. Ann Thorac Surg 2002; 73: 1196-1202; discussion 1202- 1203.
  • Nashaf Sam, Roques F, Michel P et al. . European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16: 9–13.
  • Patel NC, Garyson AD, Jackson M, et al. The effect of offpump coronary bypass surgery on in-hospital mortality and morbidity. Eur J Cardiothorac Surg 2002; 22: 255-260.
  • Hart JC, Puskas JD, Sabik JF. Off-pump coronary revascularization: Current state of art. Semin Thorac Cardiovasc Surg 2002; 14: 70- 81.
  • Puskas JD, Wright CE, Ronson RS, et al. Clinical outcomes and angiographic patency in 125 consecutive off-pump coronary bypass patients. Heart Surg Forum 1999; 2: 216-221.
  • Paç M, Akçevin A, Aka SA, Büket S, Sarıoğlu T. Kalp ve Damar Cerrahisi. Ankara 2004:726- 727
  • Ascine C, Lloyd CT, Underwood MJ,Gomes WJ, Angelini GD. On-pomp versus Off-pomp coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999; 68: 493-498.
  • Jerrold HL, Kenichi AT. Inflammatory response to cardiopulmonary bypass. Ann Thoracic Surg 2003; 75: 711-720.
  • Gerritsen WBM , van Boven WJP, Driesssen AHA, Haas FJLM, Aarts LPHJ. Off versus on- pump coronary artery bypass grafting: oksidative stress and renal function. Eur J Cardiothoracic Surg 2001; 20: 923-929.
  • Gu YJ, Mariani MA, van Oeveren W, Grandjean JG, Boonstra PW. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting. Ann Thorac Surg 1998; 65: 420-424.
  • Brasil LA, Gomes WJ, Salomao R, Buffolo E .Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998; 66: 56-59
  • Fransen E, Maessen J, Dentener M, et al. Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest 1998; 113: 1290-1295.
  • Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): A pooled analysis of two randomised controlled trials. Lancet 2002; 359: 1194-1199.

Clinical outcome off-pump coronary artery bypass grafting

Yıl 2004, Cilt: 1 Sayı: 4, 17 - 20, 01.08.2004

Öz

Background: In the recent years, off-pump coronary artery bypass OPCAB surgery has become an established surgical technique especially in Euroscore > 5 patients. The purpose of this study is to investigate the results of on the beating heart coronary bypass surgery in patients with Euroscore > 5. Methods: Eighty-six patients operated on the beating heart between April 2002 and January 2005 were included in this study. Mean age of patients 61.5 ± 8.9 years and 89.64% were male. Preoperative patşent risk factor was; smoking 23 patient 27.90% , diabetes mellitus 19 patient 23.25% , hypertansion 34 patient 40,69% and cronic obstruktive lung disease in 6 patient. Results: Mean of left ventricular ejection fraction of all patients was 42 ± 9.1%, Euroscore was 9.7 ± 3.1. The mean number of bypassed grafts was 1.99 ± 0.6. Mean stay at intensive care unit 19 ± 5.2 hour, and at hospital 7.5 ± 1.5 days. İntra-aortic balloon pump was used in eight patients 4.6% . Five patients 5.8% received endarterectomy of at least one coronary artery. Hospital mortality was 3.4% with 3 patients. Conclusions: Off-pump CABG can be performed with low mortality and morbidity in patients with Euroscore>5

Kaynakça

  • Cleveland JC Jr, Shroyer AL, Chen AY, Peterson E, Grover FL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001; 72: 1282–1289.
  • Plomondon ME, Cleveland JC Jr, Ludwig ST, et al. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg 2001; 72: 114– 119.
  • Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 2002; 359: 1194–1199.
  • Magee MJ, Jablonski KA, Stamou SC, et al. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients. Ann Thorac Surg 2002; 73: 1196-1202; discussion 1202- 1203.
  • Nashaf Sam, Roques F, Michel P et al. . European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16: 9–13.
  • Patel NC, Garyson AD, Jackson M, et al. The effect of offpump coronary bypass surgery on in-hospital mortality and morbidity. Eur J Cardiothorac Surg 2002; 22: 255-260.
  • Hart JC, Puskas JD, Sabik JF. Off-pump coronary revascularization: Current state of art. Semin Thorac Cardiovasc Surg 2002; 14: 70- 81.
  • Puskas JD, Wright CE, Ronson RS, et al. Clinical outcomes and angiographic patency in 125 consecutive off-pump coronary bypass patients. Heart Surg Forum 1999; 2: 216-221.
  • Paç M, Akçevin A, Aka SA, Büket S, Sarıoğlu T. Kalp ve Damar Cerrahisi. Ankara 2004:726- 727
  • Ascine C, Lloyd CT, Underwood MJ,Gomes WJ, Angelini GD. On-pomp versus Off-pomp coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999; 68: 493-498.
  • Jerrold HL, Kenichi AT. Inflammatory response to cardiopulmonary bypass. Ann Thoracic Surg 2003; 75: 711-720.
  • Gerritsen WBM , van Boven WJP, Driesssen AHA, Haas FJLM, Aarts LPHJ. Off versus on- pump coronary artery bypass grafting: oksidative stress and renal function. Eur J Cardiothoracic Surg 2001; 20: 923-929.
  • Gu YJ, Mariani MA, van Oeveren W, Grandjean JG, Boonstra PW. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting. Ann Thorac Surg 1998; 65: 420-424.
  • Brasil LA, Gomes WJ, Salomao R, Buffolo E .Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998; 66: 56-59
  • Fransen E, Maessen J, Dentener M, et al. Systemic inflammation present in patients undergoing CABG without extracorporeal circulation. Chest 1998; 113: 1290-1295.
  • Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): A pooled analysis of two randomised controlled trials. Lancet 2002; 359: 1194-1199.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Makalesi
Yazarlar

Osman Tansel Darçın Bu kişi benim

Alper Sami Kunt Bu kişi benim

Mehmet Salih Aydın Bu kişi benim

Cüneyt Şelli, Bu kişi benim

Yayımlanma Tarihi 1 Ağustos 2004
Yayımlandığı Sayı Yıl 2004 Cilt: 1 Sayı: 4

Kaynak Göster

Vancouver Darçın OT, Kunt AS, Aydın MS, Şelli, C. Atan kalpte koroner arter bypass cerrahisi sonuçlarımız. Harran Üniversitesi Tıp Fakültesi Dergisi. 2004;1(4):17-20.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty