Effects of Left Internal Thoracic Artery Graft Use on Coronary Artery Bypass Grafting Mortality and Morbidity in Octogenarians

Abstract

Introduction: Atherosclerotic heart disease is the leading cause of death in developed countries. In our country, the numbers are slightly lower, but increase each year. In 2008, the number of cases was 10.410 (12.03%) of all deaths among people aged 75 and over. The proportion of octogenarians undergoing cardiac surgery is increasing, although this high risk population has many unknown issues to decrease mortality and morbidity.The aim of this study was to understand and compare the role of left internal thoracic artery (LITA) versus saphenous vein (SVG) to left anterior descending artery (LAD) grafting on early- and mid-term results.

Patients and Methods: A retrospective analysis was conducted on 105 consecutive patients who were 80 years of age or older and who underwent isolated coronary artery bypass grafting (CABG) between January 2000 and January 2010. Patients with saphenous venous graft only (SVG; n: 27) were compared with those receiving arterial (LITA; n: 78) and saphenous venous grafts. Mean follow-up was 42.95 ± 23.36 months.

Results: There was no significant difference in mortality and morbidity between the groups (p> 0.05). A longer duration of aortic cross-clamping was found to be associated with postoperative renal failure in patients with saphenous venous grafts (p< 0.05). There was no statistically significant difference in 8-year survival rates between the groups (p> 0.05).

Conclusion: In conclusion, octogenarians should receive complete revascularization with short aortic cross-clamp time. We could not demonstrate the importance of graft choice for long-term functional outcome and survival as a prognostic factor in this age group who underwent coronary artery bypass surgery. 

Keywords

• Octogenarian,coronary artery bypass grafting,left internal thoracic artery,saphenous vein graft

Seksenli Yaş Grubunda Koroner Baypasta Sol İnternal Torasik Arter Grefti Kullanımının Mortalite ve Morbiditeye Etkisi

Abstract

Giriş: Aterosklerotik kalp hastalığı gelişmiş ülkelerde en önemli ölüm nedenidir. Ülkemizde de giderek artan bir yüzdeyle mortalitede üst sıralarda bulunmaktadır. 2008 yılında 75 yaş üstü nüfusun %12.03’ünde ölüm nedeninin iskemik kalp hastalığı olduğu saptanmıştır. Kalp cerrahisinde giderek artan bir yüzdeye sahip olan seksenli yaş grubunda operatif mortalite ve morbiditeyi azaltmak için araştırılması gereken pek çok başlık mevcuttur. Çalışmamızda koroner arter baypas greft (CABG) yapılan seksenli yaş grubu hastalarda sol ön inen koroner arter baypasında safen ven (SVG) veya sol internaltorasik arter grefti (LITA) seçiminin erken ve orta dönem mortalite açısından rolünü araştırdık.

Hastalar ve Yöntem: Ocak 2000-Ocak 2010 yılları arasında izole CABG operasyonu uygulanmış seksenli yaş grubunda 105 hasta çalışmaya dahil edilerek retrospektif olarak incelendi. LITA kullanılan [LITAgrubu (n: 78)] ve kullanılmayan [SVG grubu (n: 27)] hastalar kıyaslandı. Ortalama takip süresi 42.95 ± 23.36 aydı.

Bulgular: Mortalite ve morbidite açısından her iki grup arasında istatistiksel anlamlı fark izlenmedi (p> 0.05). SVG grubunda uzun aortik kros klemp süresi ile postoperatif renal yetmezlik arasında ilişki olduğu bulundu (p< 0.05). Sekiz yıllık takipte hayatta kalım açısından her iki grup arasında istatistiksel fark yoktu (p> 0.05).

Sonuç: Seksenli yaş grubu hastalarda beklenen kısa yaşam sürelerine rağmen komplet revaskülarizasyon ve kısa aortik kros klemp süresi ile CABG başarıyla uygulanabilir. Bizim çalışmamızda LITA kullanımı mortaliteye etkili bulunmamıştır.

Keywords

• Seksenli yaş grubu (oktogenaryan),koroner arter baypas greftleme,sol internal torasic arter,safen ven

References

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