Effects of 72-Hour Trimethazidine in Open Heart Surgery on Myocardial Ischemia

Öz

Objective: The aim of this study is to show the effects of 72-hour long trimethazidine (TMZ) administration on myocardial ischemia before open heart surgery.

Material and Methods: This prospective study was carried out between 2009 and 2010 in Eskişehir Osmangazi University Faculty of Medicine, Department of Cardiovascular Surgery. A total of 20 patients, 12 male and 8 females, aged between 43-76 years, who were scheduled for elective coronary artery bypass graft operation were included in the study. The patients were divided into two groups. 3 × 20 mg oral TMZ was given to the first group 72 hours before the preoperative period (study group). Group 2 was the control group. Patients who had myocardial infarction within the last 6 weeks, who underwent additional cardiac surgery to coronary artery bypass surgery, who had previous kidney disease, who had high cardiac enzyme levels 24 hours before surgery, and who were hemodynamically unstable were excluded from the study. Age, body surface area, gender, ejection fraction, comorbidity, cardiopulmonary bypass time, cross-clamp time, patient vessel number and bypass numbers were recorded. Blood samples for the troponin-I (TnI) base value were taken just before the patient was anesthetized. When the cross-clamp was removed during the operation, a second sample was taken from the right atrium. Blood samples for TnI were taken at 6, 12 and 24 hours after the cross-clamp was removed.

Results: When the TnI values were measured just before the patients were anesthesized, immediately after the cross-clamp was removed, and at the 6th, 12th and 24th hours, there was no statistically significant difference between the groups (p=0.7734, p=0.3390, p=0.5624, p=0.1296, p=0.1796, respectively).

Conclusion: It was found that preoperative short-term TMZ treatment had no effect on myocardial protection in open heart surgery.

Anahtar Kelimeler

• Coronary bypass
• trimethasidine
• troponin I
• myocardial damage

AÇIK KALP CERRAHİSİNDE 72 SAATLİK TRİMETAZİDİN UYGULAMASININ MİYOKARD İSKEMİSİ ÜZERİNE ETKİLERİ

Öz

Amaç: Bu çalışmanın amacı açık kalp cerrahisi öncesi 72 saatlik trimetazidin (TMZ) uygulamasının miyokard iskemisi üzerine etkilerini göstermektir.

Gereç ve Yöntemler: Bu çalışma, 2009-2010 tarihleri arasında, Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalında prospektif olarak gerçekleştirildi. Çalışmaya elektif koroner arter bypass greft operasyonu planlanan, yaşları 43-76 yıl aralığında olan, 12’si erkek, 8 kadın olmak üzere toplam 20 hasta alındı. Hastalar iki gruba ayrıldı. Birinci gruba 72 saat öncesinden başlayarak preoperatif 3x20 mg, oral TMZ verildi (çalışma grubu). İkinci grup kontrol grubuydu. Son 6 hafta içinde miyokard enfarktüsü geçirmiş olan, koroner arter bypass cerrahisine ek kardiyak cerrahi uygulanan, önceden böbrek hastalığı olan, cerrahiden 24 saat önce kardiyak enzim düzeyleri yüksek olan ve hemodinamik açıdan stabil olmayan hastalar çalışma dışı bırakıldı. Yaş, vücut yüzey alanı, cinsiyet, ejeksiyon fraksiyonu, komorbidite, kardiyopulmoner bypass zamanı, kros-klemp zamanı, hasta damar sayısı ve bypass sayıları kaydedildi. Troponin I (TnI) baz değeri için kan numuneleri hasta uyutulmadan hemen önce alındı. Operasyon sırasında kros-klemp kaldırılınca sağ atriyumdan ikinci örnek alındı. Kross-klemp kaldırıldıktan sonra 6., 12. ve 24. saatlerinde TnI için kan örnekleri alındı.

Bulgular: Hastalar uyutulmadan hemen önce, kros-klemp kaldırıldıktan hemen sonra ve 6. 12. ve 24. saatlerde bakılan TnI değerleri gruplar arasında karşılaştırıldığında istatistiksel olarak anlamlı bir fark saptanmadı. (sırasıyla, p=0.7734, p=0.3390, p=0.5624, p=0.1296, p=0.1796).

Sonuç: Açık kalp cerrahisinde preoperatif kısa süreli TMZ tedavisinin miyokard korunması üzerine bir etkisinin olmadığı tespit edildi.

Anahtar Kelimeler

• Koroner bypass
• trimetazidin
• troponin I
• miyokard hasarı

Kaynakça

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