Experience of Coronary Artey Bypass Grafting Surgery for Advanced Age Patients

Yıl 2012, Cilt: 3 Sayı: 10, 9 - 16, 03.03.2015

Hasan Umcu Mehmet Acıpayam Tolga Badak Serkan Ketenciler Habib Çakır İbrahim Özsöyler

Öz

Aim: Number of the advanced age patients
undergoing coronary artery bypass surgery (CABG)
are increasing. Perioperative and postoperative
morbidity and mortality rates remain high for
advanced age patients when this group are
compared to the younger patients group. In this
article, we aimmed that to evaluate retrospectively
early period results of operation and demographic
datas of the 80 years old and over patients who
undergone isolated CABG with cardiopulmonary
bypass (CPB).
Patients and Methods: Twenty two patients that
80 years old and over underwent elective isolated
CABG operation with CPB in Cardiovascular
Surgery Clinic of Adana Numune Resarch and
Training Hospital between January 2004 and May
2012. The demographic datas of the patients and
perioperative and postoperative parameters were
evaluated.
Results: Mean age of patients was 82.3±3.9 (80-
97), 17 of them were male and 5 female. 54.5 % of
the patients were smokers, 22.7 % of them diabetes
mellitus, 40.9 % of them hipertension and 13.6 %
of them chronic obstructive pulmonary disease.
22.7 % of patients had one vessel disease, 18.2 %
of them had two vessels disease and 59.1 % of them
had three vessels disease. Mean aortic cross clemp
time was 38.8±15.2 minutes, total cardiopulmonary
bypass time 78.5±35 minutes and ratio of internal
thoracic artery usage was 63.6 %. Inotropic drugs
usage needed for 72.7 % of patients when weaning
from cardiopulmonary bypass. Intraaortic baloon
pump was performed for one patient (4.5 %). In
postoperative period, delirium was seen 13.6 % of
patients (3 cases), stroke was 4.5 % (1 case), atrial
fibrillation was 13.6 % (3 cases) and wound
infection was 4.5 % (1 case). Two patients were
reoperated for drainage in postoperative early
period and mortality was not seen.
Conclusion: Coronary bypass surgery for advanced
age patients can be applied successfully with
acceptable hospital mortality rate in spite of
increase of postoperative complication rate,
duration of hospitalization and morbidity. 

Anahtar Kelimeler

Coronary Artery Bypass Surgery, Advanced Age, Risk Factors

İLERİ YAŞLI HASTALARDA KORONER BYPASS DENEYİMİ

Öz

Amaç: İleri yaş hastalarda koroner arter bypass cerrahisi (CABG) giderek artmaktadır. Daha genç hasta grubu ile karşılaştırıldığında bu grup hastalarda perioperatif ve postoperatif morbidite ve mortalite yüksek seyretmektedir. Bu yazımızda, kliniğimizde kardiyopulmoner bypas (CPB) altında izole CABG operasyonu yapılan 80 yaş ve üzerindeki hastaların demografik verileri ve operasyonun erken dönem sonuçlarını retrospektif olarak değerlendirmeyi amaçladık. Hastalar ve Yöntem: Ocak 2004 - Mayıs 2012 yılları arasında Adana Numune Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahi Kliniğinde elektif şartlarda 80 yaş ve üzerinde 22 hastaya CPB altında izole CABG operasyonu uygulanmıştır. Hastaların demografik verileri ile perioperatif ve postoperatif parametreleri değerlendirildi.Bulgular: Hastaların 17’si erkek, 5’i kadın, ortalama yaş 82.3±3.9 (80-97) idi. Hastaların%54.5’i sigara içmekte olup, %22.7’sinde diyabetes mellitus, %40.9’unda hipertansiyon, %13.6’sında kronik obstrüktif akciğer hastalığı mevcuttu. Hastaların %22.7'sinde tek damar, %18.2'sinde iki damar, %59.1'inde üç damar lezyonu mevcuttu.Ortalama aortik kross klemp 38.8±15.2 dakika, total CPB zamanı 78.5±35 dakika, sol internal mamariyal arter kullanım oranı %63.6 idi. CPB’dan ayrılma esnasında olguların %72.7’sinde inotropik destek gereksinimi oldu. Bir hastaya (%4.5) intraaortik balon pompası (İABP) uygulandı. Postoperatif dönemde olguların %13.6’sında (3 olgu) deliryum, %4.5’inde (1 olgu) stroke, %13.6’sında (3 olgu) atriyal fibrilasyon, %4.5’inde (1 olgu) yara yeri enfeksiyonu gelişmişti. İki hasta postoperatif erken dönemde kanama nedeniyle revizyona alınmış olup, mortalite görülmemiştir. Sonuç: İleri yaş grubundaki hastalarda postoperatif komplikasyon oranı, hastane yatış süresi, morbiditenin artmasına karşın bu hastalarda da koroner bypass cerrahisi kabul edilebilir hastane mortalitesi ile başarıyla uygulanabilmektedir..

Anahtar Kelimeler

Koroner Arter Bypass Cerrahisi, İleri Yaş, Risk Faktörleri

Kaynakça

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• Tablo 1: Olguların demografik verileri VKI: Vücut kitle indeksi; DM: Diyabetes mellitus; EF; Ejeksiyon fraksiyonu; HT: Hipertansiyon; KOAH: Kronik obstrüktif akciğer hastalığı; LMCA: Sol ana koroner arter; LDL: Düşük dansiteli lipoprotein; PTCA: Perkütan transluminal koroner anjioplast Minimum-Maksimum Yaş 3±3.9 97 VKI 5±3.5 35 LDL (mg/dl) ±36.3 185 EF (%) 7±8.2 68 Euroscore 4±1.4 9 Evet Yüzde (%) Cinsiyet Erkek 3 DM 7 HT 9 KOAH 6 Sigara 5 Obesite 8 Hiperlipidemi 5 Düşük EF (<%30) 6 PTCA 2 LMCA hastalığı 6 Tek damar hastalığı 7 İki damar hastalığı 2 Üç damar hastalığı 1