Koroner Baypas Cerrahisinde İleri Yaş Grubunda Sol İnternal Torasik Arter Kullanımı

Yıl 2023, , 22 - 25, 30.03.2023

Haydar Yaşa

https://doi.org/10.57221/izmirtip.1239771

Öz

Amaç: Koroner baypas cerrahisinde sol internal torasik arter (LİTA) greftinin kullanılması, daha iyi erken ve geç açıklık ve daha iyi sağ kalım ile sonuçlandığı gösterilmiştir. Arteriyel greftleme, periferik arter hastalığı, kronik obstrüktif akciğer hastalığı, diyabet ve böbrek bozukluklarının daha yüksek prevalansı nedeniyle yaşlı hastalarda uygunsuz kabul edilebilir. Bu çalışmada, LİTA kan akımı, 75 yaşın üzerindeki bir grup hastada diğer tüm bileşenlerden bağımsız olarak ölçülmüştür. Diğer yaş grupları ile anlamlı bir fark olup olmadığının belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Mart 2016 ile Kasım 2021 arasında, ardışık 84 hastaya primer koroner arter baypas greftleme uygulandı. Bu çalışma, tek merkezli, prospektif, randomize bir analizdir. Hastalar üç gruba ayrıldı: Grup I: 60≤ yaş, Grup II: 60-75 yaş ve Grup III: ≥75 yaş üstü. Bulgular: Sol internal torasik arter kan akımları üç grupta ölçüldü: Grup I: 83,7±12,4 ml/dk, Grup II: 79,5±13,4 ml/dk ve Grup III: 78,6±10,6 ml/dk (p≤0,76). Ortalama kan akımı erkeklerde 84,6±14,8 ml/dk, kadınlarda 76,8±9,4 ml/dk (p≤0,05), diyabetiklerde 76,4±12,4 ml/dk, olmayanlarda 86.6±12.8 ml/dk (p≤0.05) idi. Aktif olarak spor yapan hastalarda 88,6±14,2 ml/dk, sporla uğraşmayan hastalarda 78,3±11,3 ml/dk (p≤0,05) bulundu. Sonuç: Sonuç olarak, LİTA kan akımı yaştan etkilenmez. Arteriyel greftlerin koroner arter baypas greftlemesinde mükemmel greftler olduğu genel olarak kabul görmektedir. Bu çalışmada yaşlı gruplarda da LİTA kullanımının yararlı olduğu ve yaşlı popülasyonda da daha çok kullanılması gerektiği sonucu çıkmaktadır.

Anahtar Kelimeler

Koroner bay pas, ileri yaş, greft, greft

Use of left internal thoracic artery in the advanced age group in coronary bypass surgery

Öz

Aim: The use of internal thoracic artery graft in coronary bypass surgery has been shown to result in better early and late patency and improved survival. Arterial grafting may be considered inappropriate in elderly patients due to the higher prevalence of peripheral artery disease, chronic obstructive pulmoner disease, diabetes, and renal disorders. In the present study, left internal thoracic artery (LİTA) blood flow was measured independently from all other components in a group of patients above 75 years of age. An analysis was made to determine if there was significant difference between the other age groups. Material and methods: Between March 2016 and November 2021, primary coronary artery bypass was performed in 84 consecutive patients. The present study is a single-center, prospective, randomized analysis. The patients were divided into three groups: Group I: 60≤ years, Group II: 60-75 years, and Group III: above ≥75 years. Results: Left internal thoracic artery blood flows were measured in the three groups as follows: Group I: 83.7±12.4 ml/min, Group II: 79.5±13.4 ml/min, and Group III: 78.6±10.6 ml/min (p≤0.76). Mean blood flow was 84.6±14.8 ml/min in males, 76.8±9.4 ml/min (p≤0.05) in females, 76.4±12.4 ml/min in diabetics, 86.6±12.8 ml/min (p≤0.05) in non-diabetics, 88.6±14.2 ml/min in patients actively engaged in athletic activities, and 78.3±11.3 ml/min (p≤0.05) in patients who are not engaged in athletic activities. Conclusion: LİTA blood flow is not affected by age. It is a common notion that arterial grafts are excellent conduits in coronary artery bypass grafting. This also seems applicable to elderly patients considering isolated LİTA blood flow. Therefore, the researchers of the current study believe that the use of arterial grafting should be increased in elderly patients.

Anahtar Kelimeler

coronary bypass surgery, greft, advanced age

Kaynakça

• Referans1. Lytle BW, Loop FD, Cosgrove FD, Ratliff NB, Easley K, Taylor PC. Long-term (5–12 years) serial studies of internal thoracıc artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg. 1985;89:248-58.
• Referans2. Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW et al. Influence of internal thoracıc artery graft on 10-year survival and other cardiac events. N Engl J Me.d 1986;314:1-6.
• Referans3. Cameron AA, Green GE, Brogno DA, Thornton J. Internal thoracic artery grafts: 20-year clinical follow-up. J Am Coll Cardiol. 1995;25:188-92.
• Referans4. Barner HB, Swartz MT, Mudd JG, Tyras DH. Late patency of the internal thoracıc artery as a coronary bypass conduit. Ann Thorac Surg. 1982;34:408-12.
• Referans5. Cameron A, Kemp HG Jr, Green GE. Bypass surgery with the internal thoracıc artery graft: 15 year follow-up. Circulation. 1986;74:30-6.
• Referans6. Barner HB, Standeven JW, Reese J. Twelve-year experience with internal thoracıc artery for coronary artery bypass. J Thorac Cardiovasc Surg. 1985;90:668-75.
• Referans7. Cameron A, Davis KB, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic-artery grafts - effects on survival over a 15-year period. N Engl J Med. 1996;334:216-19.
• Referans8. Morris RJ, Strong MD, Grunewald KE, Kuretu ML, Samuels ML, Kresh JY et al. Internal thoracic artery for coronary artery grafting in octogenarians. Ann Thorac Surg. 1996;62:16-22.
• Referans9.Rihal CS, Raco DL, Gersh BJ, Yusuf S: Indications for coronary artery bypass surgery and percutaneous coronary intervention in chronic stable angina: review of the evidence and methodological considerations. Circulation. 2003;108:2439-45.
• Referans10. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al. ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation. 2011;124: 2610-42.
• Referans11. Yusuf S, Zucker D, Passamani E, Peduzzi P, Takaro T, Fisher LD et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the coronary artery bypass graft surgery trialists collaboration. Lancet. 1994;344:563–570.
• Referans12. Favarato ME, Hueb W, Boden WE, Lopes N, Nogueira CR, Takiuti M et al. Quality of life in patients with symptomatic multivessel coronary artery disease: a comparative post hoc analyses of medical, angioplasty or surgical strategies-MASS II trial. Int J Cardiol 2007; 116:364-70.
• Referans13. Kappetein AP, Feldman TE, Mack MJ, Morice MC, Holmes DR, Stahle E et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J, 2011;32: 2125-34.
• Referans14. Drouin A, Noiseux N, Chartrand-Lefebvre C, Soulez G, Mansour S, Tremblay JA et al. Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial. Trials. 2013;14:270.
• Referans15.Moller CH, Perko MJ, Lund JT, Andersen LW, Kelbaek H, Madsen JK et al. Graft patency after off-pump versus on-pump coronary artery surgery in high-risk patients. Scand Cardiovasc J. 2010;44: 161-67.
• Referans16.Bridgewater B, Grayson AD, Au J, Hassan R, Dihmis WC, Munsch C et al. Improving mortality of coronary surgery over first four years of independent practice: retrospective examination of prospectively collected data from 15 surgeons. BMJ. 2004;329:421.
• Referans17. Muneretto C, Negri A, Manfredi J, Terrini A, Rodella G, Elgarra S et al. Safety and usefulness of composite grafts for total arterial myocardial revascularization (a prospective and randomised evaluation). J Thorac Cardiovasc Surg. 2003;125:826-35.
• Referans18. S Karthık, B. Fabrı. Left internal thoracıc artery usage in coronary artery bypass grafting: a qualıty control marker. Ann R Coll Surg Engl. 2006;88:367-69.