Rezan AKSOY, Mutlu ŞENOCAK, Didem Güngör ARSLAN, Yavuz ŞENSÖZ, Fatih ÖZDEMİR, Ahmet Yavuz BALCI, Murat SARGIN, Uğur KISA, İbrahim YEKELER

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

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

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

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.

Keywords:

Coronary bypass, percutaneous coronary intervention; cardiopulmonary bypass; mortality,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi