Comparison of Complications in Elderly Patients Undergoing Coronary Artery Bypass Surgery with or without Use of the Left Internal Thoracic Artery

Öz

Introduction: This study aimed to compare postoperative complications in elderly patients who underwent coronary artery bypass grafting surgery with or without use of the left internal thoracic artery.Patients and Methods: In this retrospective clinical study, 40 patients over 75 years old undergoing coronary artery bypass grafting surgery between September 2011 and December 2013 in our clinic were included. Twenty of the patients underwent coronary surgery with LITA and the other 20 patients underwent without LITA. We compared the two groups on the basis of postoperative mechanical complications.Results: Postoperative pneumothorax was seen in 3 patients (15%, p=0.03) who had undergone coronary artery surgery with LITA. Sternal dehiscence was seen in one patient (5%, p=0.047) and sternal infection was seen in one other patient (5%, p=0.047) in whom LITA was used. None of these complications were seen in patients in whom LITA was not used.Conclusion: Postoperative complications such as pneumothorax, sternal dehiscence and sternal infection were more common in elderly patients in whom LITA was used. However, in consideration of the important superiorities of LITA, this graft cannot be easily abandoned. In conclusion, if the required measures are taken in the elderly without diabetes mellitus, osteoporosis, pre-operative pulmonary disease which would negatively affect the post-operative prognosis, complications related with LITA grafting would not be as serious as to refrain from using this graft in elderly patients.

Anahtar Kelimeler

• Left internal thoracic artery, elderly; coronary artery by-pass

Sol İnternal Torasik Arter Kullanılarak ve Kullanılmayarak Koroner Arter Bypass Cerrahisine Giden Yaşlı Hastalarda Komplikasyonların Karşılaştırılması

Öz

Giriş: Bu çalışma ile koroner arter bypass cerrahisine giden yaşlı hastalarda, sol internal torasik arter grefti kullanılanlar ile kulanılmayanların postoperatif komplikasyonlar açısından karşılaştırılması amaçlanmıştır.Hastalar ve Yöntem: Kliniğimizde Eylül 2011 ile Aralık 2013 tarihleri arasında koroner bypass cerrahisine giden 75 yaş üstü hastalardan sol internal torsik arter kulanılan 20 hasta ve kullanılmayan 20 hasta retrospektif olarak değerlendirilmiştir. Toplam 40 hasta sol internal torasik arter grefti hazırlanan grup 1 ve hazırlanmayan grup 2 olmak üzere postoperatif mekanik komplikasyonlar açısından karşılaştırılmıştır.Bulgular: Postoperatif pnömotorax, LİTA kullanılan grupta 3 hastada (%15 p=0,03), sternal dehiscence ve sternal enfeksiyon ise yine LİTA kullanılan grupta birer hastada (%5, p=0,047) görülürken LİTA kullanılmayan grupta bu komplikasyonlar hiçbir hastada tesbit edilmedi.Sonuç: Sol internal torasik arter grefti hazırlanan yaşlı hastalarda pnömotorax, sternal dehiscence ve sternal enfeksiyon gibi postoperatif komplikasyonlar daha yaygındı. Ancak LİTA grefti çok önemli üstünlükleri düşünüldüğünde kolay vazgeçilebilecek bir greft değildir. Sonuç olarak, diabetes mellitus, osteoporozis, preoperatif pulmoner hastalık gibi postoperatif dönemde prognozu olumsuz etkileyebilecek sorunları olmayan yaşlı hastalarda gerekli önlemler alındığında, LİTA greft hazırlanmasına bağlı komplikasyonların, yaşlılarda bu greftin kullanımının kısıtlanmasını gerektirecek düzeyde olmadığını düşünmekteyiz.

Anahtar Kelimeler

• Sol internal torasik arter, yaşlı; koroner by-pass

Kaynakça

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