Is Coronary Bypass Operation More Risky in Patients Undergoing Previous Percutaneous Coronary Intervention?

Yıl 2014, Cilt: 17 Sayı: 1, 30 - 36, 01.01.2013

Rezan Aksoy Mutlu Şenocak Didem Güngör Arslan Yavuz Şensöz Fatih Özdemir Ahmet Yavuz Balcı Murat Sargın Uğur Kısa İbrahim Yekeler

Öz

OBJECTIVE: In this study we compare the factors affecting mortality and morbidity of the patients had coronary artery bypass graft (CABG) with/without percutaneous coronary intervention (PCI) prior to the CABG operation.METHODS: In our study a total of 214 patients who underwent CABG in our hospital between January 2006-2008 were included. They were divided into two groups as A and B. In group A, 135 patients in whom CABG was performed after PCI (mean age 52.5±8.8 years) were included; in group B, 79 patients in whom CABG was performed without any coronary intervention (mean age 51.8±8.8 years) were included. Both groups were evaluated in terms of demographic characteristics, comorbid diseases and medications, preoperative ejection fraction (EF) and functional capacity, durations of preoperative cardiopulmonary bypass (CPB) and cross clamp, number of distal bypass, whether bypass was performed on the coronary artery undergoing PCI, inotropic agent or intra-aortic balloon pump support at the time of referring to postoperative intensive care unit (ICU), duration of postoperative ICU stay and complications.RESULTS: Of the patients, 85% were males and 15% were females. In 73% (n=98) of the patients undergoing CABG following PCI, bypass was performed also on the artery undergoing PCI. The rate of malignant arrhythmia was higher in the group A in which CABG was performed following PCI as compared to the group B (8% (n=11) in the group A, 1% (n=1) in the group B). The rate of development of cerebrovascular event (CVE) was 4% (n=5) in the group A and 1% (n=1) in the group B. Postoperative mortality was 15% (n=22) in the group A and 3% (n=2) in the group B.CONCLUSION: Although PCI may be a life-saving procedure in patients presenting with acute myocardial infarction, some serious complications may occur during the procedure. So an urgent surgical intervention may be necessary. In this study, mortality and morbidity of the CABG procedures performed after PCI are reported to be high.

Anahtar Kelimeler

Coronary bypass, percutaneous coronary intervention; cardiopulmonary bypass; mortality

Öncesinde Perkütan Koroner Girişim Uygulanmış Hastalarda Koroner Bypass Daha mı Risklidir?

Öz

AMAÇ: Bu çalışmada, perkutan koroner girişim (PKG) sonrası koroner arter baypass greftleme (KABG) operasyonu uygulanan hastalarla, hiçbir perkutan koroner girişim olmaksızın KABG operasyonu geçiren hastaların mortalite ve morbiditeyi etkileyen faktörler açısından sonuçlarının karşılaştırılması amaçlandı.YÖNTEMLER: Ocak 2006 ve Ocak 2008 tarihleri arasında hastanemizde KABG uygulanmış olan 214 hasta çalışmaya dahil edildi. A ve B olmak üzere hastalar iki gruba ayrıldı. A grubuna, PKG sonrası KABG uygulanan 135 hasta (yaş ortalaması 52,5±8,8) dahil edilirken; B grubuna, hiçbir perkutan koroner girişim geçirmeksizin KABG uygulanan 79 hasta (yaş ortalaması 51,8±8,8) dahil edildi. Her iki grubun demografik özellikleri, komorbid hastalıkları ve kullandığı medikal tedaviler, preoperatif EF (ejeksiyon fraksiyonu) ve fonksiyonel kapasitesi, peroperatif kardiyopulmoner baypas (CPB) ve kros klemp süresi, distal bypass sayısı, PKG uygulanmış olan koroner artere baypas uygulanıp uygulanmadığı, postoperatif yoğun bakıma alınırkenki inotropik ajan veya intraaortik balon pompası (İABP) desteği, postoperatif yoğun bakımda hastanede yatış süresi ve komplikasyonları açısından değerlendirildi.BULGULAR: Araştırma kapsamında örneklemeye dahil edilen hastaların %85'i erkek, %15'i ise kadındı. PKG sonrası KABG uygulanan hastaların %73'ünde (n=98), PKG uygulanan damara da baypas yapıldı. PKG sonrası KABG uygulanan A grubunda, malign aritmi görülme oranı B grubuna göre belirgin derecede yüksekti (A grubunda %8 n=11; B grubunda %1 n=1). Postoperatif serebro vasküler olay (SVO) gelişimi, A grubunda %4 (n=5); B grubunda %1 (n=1)'di. Postoperatif mortalite, PKG sonrası KABG uygulanan A grubunda %15 (n=22), B grubunda ise %3 (n=2)'dü.SONUÇ: PKG, akut miyokard enfarktüsü ile başvuran hastalarda hayat kurtarıcı olabilmekle birlikte, işlem sırasında ciddi komplikasyonlar gelişebilmektedir. Çalışmamızda PKG sonrası uygulanan KABG operasyonlarının mortalitesi ve morbiditesinin yüksek olduğu görülmektedir.

Anahtar Kelimeler

Koroner bypass, perkütan koroner girişim; kardiyopulmoner bypass; mortalite

Kaynakça

• Ito C, Sasaki H, Ishida S, Maade R, Hareda H. Is insulin resistance the main cause of impaired fasting glycemia? The International Diabetes Federation Abstract Volume of The 18th Congress. S:144
• SoS Investigators. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery trial): A randomised controlled trial. Lancet 2002;360:965-70.
• Erdoğan HB, Erentuğ V, Sareyyüpoğlu B, Sönmez K, Güzelmeriç F, Kırali K, ve ark. İntrakoroner Stent İmplantasyonu Sonrası KABG Uygulanan Olguların Klinik ve Anjiyografik Özellikleri. Turk Gogus Kalp Dama 2005;13:1-5.
• Ökmen E, Şanlı A, Kaşıkçıoğlu H, Dayı S, Cam N. Effects of glycoprotein IIb/IIIa inhibition with tirofiban on minor myocardial injury in successful coronary angioplasty. Cardiology 2004;102;18-23.
• Ökmen E, Kaşıkçıoğlu H, Uyarel H, Erdem I, Vural M. The effects of direct stent implantation and conventional stent implantation on minor myocardial injury in percutaneous coronary intervention. J Am Coll Cardiol 2002;39:320B.
• Mohr FW, Morice M C, Kappetein P, Feldman T E, Stalhe E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013;381:629-38.
• Hannan R L, Racz M, Walford G, Jones R H, Ryan T J, Bennett E, et al. Long-Term Outcomes of Coronary-Artery Bypass Grafting versus Stent Implantation. N Engl J Med 2005;352:2174-83.
• Hlakty MA, Boothrody DB, Baker L, Kazi DS, Solomon MD, Chang TI, et al. Comparative effectiveness of multivessel coronary bypass surgery and multivessel percutaneous coronary intervention: a cohort study. Ann Intern Med 2013;158:727-34.
• Johnson RG, Sirois C, Thurer RL, Sellke FW, Cohn WE, Kuntz RE, et al. Predictors of CABG within one year of successful PTCA: A retrospective, case-control study. Ann Thorac Surg 1997;64:3-7.
• Okmen E. Did drug eluting stents change the management of coronary artery disease in diabetic patients?. Turk Gogus Kalp Dama 2008:16:198- 204.
• Bansilal S, Farkouh ME, Hueb W, Ogdie M, Dangas G, Lansky AJ, et al. The Future revascularization evaluation in patients with diabetes mellitus: optimal management of multivessel disease (FREEDOM). Am Heart J 2012;164:591-9.
• Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’ Shaughnessy C, et al. Sirolimus-eluting stents versus standart stents in patients with stenosis in a native coronary artery. N Eng J Med 2003;349:1315-23.
• Eduardo AT, Alan B. Effects of surgical manipulation on coronary stents: Should surgical strategy be altered? Ann Thorac Surg 1997;63:37-40.