Koroner bypass cerrahisinde aantegrad kardiyopleji yönteminin antegrad-retrograd kardiyopleji yöntemi ile inflamatuar cevap ve sol ventrikül sistolik fonksiyonları açısından kıyaslanması: prospektif randomize çalışma

Yıl 2018, Cilt: 9 Sayı: 3, 179 - 184, 30.09.2018

Mustafa Cüneyt Çiçek Niyazi Görmüş Kadir Durgut Mehmet Kayrak Aysun Toker İşık Solak Görmüş Ömer Faruk Çiçek

https://doi.org/10.18663/tjcl.432111

Öz

Amaç: Özellikle proksimal darlığı olan koroner arter
hastalarında veya ciddi miyokardiyal hipertrofisi olan hastalarda antegrad
kardiyoplejinin homojen olmayan dağılımı ciddi bir problemdir. Bu prospektif
randomize çalışmada, kombine antegrad-retrograd kardiyoplejinin sadece antegrad
tekniğe kıyasla erken dönemde daha iyi miyokardiyal koruma sağlaması ve daha iyi
laboratuar sonuçları ile ilişkisi değerlendirilmiştir.

Gereç ve Yöntemler: Koroner bypass cerrahisi uygulanan 60 hasta (45 (%75)
erkek, 15 (%25) kadın) çalışmaya dahil edilmiştir ve iki grupta incelenmiştir:
Grup 1’de 30 hastaya aort kökünden antegrad ve koroner sinusten retrograd yolla
kombine kardiyopleji; Grup 2’de ise 30 hastaya aort kökünden antegrad
kardiyopleji verildi. Preoperatif, intraoperatif ve postoperative altıncı günde
alınan kan örneklerinden CK-MB, TpI, TNF- α, IL-1, IMA, ICAM-1 ve BNP parametreleri
çalışıldı. Hastalar preoperative olarak ve postoperative altıncı günde
transtorasik ekokardiyografi ile değerlendirildi.

Bulgular: Postoperatif ortalama EF düşüşü Grup 1’de Grup 2’ye
kıyasla istatistiksel olarak anlamlı şekilde daha az oldu (4.13 ± 9.09 ve 8.90
± 10.76, sırayla Grup 1 ve Grup 2, p=0.046). TNF- α seviyelerindeki değişimin
büyüklüğü kıyaslandığında Grup 2’deki artışın daha fazla olduğu bulunmuştur
(p=0.047).

Sonuçlar: Antegrad ve retrograd kardiyoplejinin birlikte
uygulanmasının, erken postoperatif dönemde tek başına antegrad kardiyoplejiye
göre daha iyi miyokardiyal koruma sağlayabileceği sonucuna vardık.

Anahtar Kelimeler

antegrad, inflamasyon, kardiyopleji, miyokardiyal koruma, retrograd

Comparison of effect of antegrade with combined antegrade/retrograde cardioplegia on inflammatory response and left ventricular systolic function in coronary bypass surgery: a prospective randomized study

Öz

Aim: Nonhomogeneous distribution of antegrade cardioplegia
especially in cases with severe myocardial hypertrophy or proximal stenosis of
coronary arteries may be a serious problem. This prospective randomized study
was designed to determine whether combined antegrade–retrograde cardioplegia
provides improved myocardial protection in the early period and is associated
with better laboratory results compared with antegrade technique alone.

Material and Methods: A total of 60 patients who underwent coronary artery
bypass grafting surgery, 45 (75%) males and 15 (25%) females, were included in
the study as 2 groups: In Group 1, 30 patients were given the combined
cardioplegia solution antegrade via the aortic root and retrograde via the
coronary sinus, in Group 2, 30 patients were given only antegrade cardioplegia
solution via the aortic root. The CK-MB, TpI, TNF- α, IL-1, IMA, ICAM-1, and
BNP parameters were studied in the blood samples which were taken
preoperatively, intraoperatively and postoperative sixth day. The patients were
evaluated preoperatively and on the sixth postoperative day using transthoracic
echocardiography.

Results: The postoperative mean EF decrease was significantly
lower in Group 1 compared to Group 2 (4.13 ± 9.09 vs 8.90 ± 10.76 in Group 1
vs. Group 2, respectively, p=0.046). When the change in TNF-α levels were
compared between groups 1 and 2, the magnitude of increase in TNF-α was
significantly higher in Group 2 (p=0.047).

Conclusion: We concluded that co-administration of antegrade and
retrograde cardioplegia may provide improved myocardial protection compared to
antegrade cardioplegia method alone in the early postoperative period.

Anahtar Kelimeler

antegrade, cardioplegia, inflammation, myocardial protection, retrograde

Kaynakça

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