Pompalı koroner arter baypaslar, kros klempli-kros klempsiz operasyonlar
Loading...
Date
2012
Authors
Türkücüoğlu, İbrahim
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Kardiyopulmoner baypas ile iki farklı yöntemle de koroner baypas yapılabilmektedir. Kros klempli yöntem, aorta klemplenerek global myokard iskemisi oluşturulmakta kalp kardiyoplejik koruma altında durdurulup bypaslar hareketsiz ortamda yapılabilmektedir. Diğer yöntemde ise aorta klemp konulmamakta, koroner arterler tek tek klemplenmekte kısa süreli bölgesel iskemiler yaratılarak kalbin çalışmasına izin verilmekte ve stabilizatör yardımıyla baypaslar yapılmaktadır. Bu iki yöntemi mortalite ve morbidite açısından birbirlerine üstünlüğü retrospektif olarak araştırmayı amaçlıyoruz.Uludağ Üniversitesi Tıp Fakültesinde Ocak 2004-Ocak 2010 tarihleri arasında 394 pompalı kros klempli operasyon ve 98 pompalı kros klempsiz operasyon uygulandı.Pompalı koroner baypaslarda kros klempli olan operasyonların, kros klempsiz olan operasyonlarla karşılaştırıldığında; mortalitenin etkilenmediği (p=0.547), hastanede kalış süresinin (p<0.001), ventilasyon süresinin (p=0.017), operasyon süresinin (p<0.001), inotrop ihtiyacının (p<0.001), kullanılan kan ürünleri miktarının (p=0.026), göğüs tüpü drenajınını (p=0.024) anlamlı derecede yüksek olduğu görüldü.Kros klemp kullanılmadığında, inotrop kullanımının, kanama miktarı ve kan ürünü kullanımı daha az olmakta, ventilasyon süresi, yoğun bakımda ve hastanede kalış süreleri de daha kısa olmaktadır. Bununla birlikte mortalite, strok, pulmoner ve renal komplikasyon açısından her iki yöntem arasında bir fark olmadığı görülmüştür.
Coronary artery bypass surgery with the aid of cardiopulmonary bypass circuit can be performed in two different ways. In aortic cross-clamping method, aorta is cross-clamped, global myocardial ischemia is maintained and the anastomoses are performed with the protection of the arrested myocardium with cardioplegic solutions on a silent non-beating heart. In empty-beating heart method, aorta is not cross-clamped and the distal anastomoses are performed with the aid of a stabilizatör on the beating heart under cardiopulmonary bypass. The coronary arteries are selectively occluded and regional ischemia is performed. In this retrospective study, we aimed to compare the results of these two methods in terms of mortality and morbidity.In Uludag University Faculty of Medicine between January 2004 and January 2010, 394 on-pump aortic cross-clamping operations and 98 on-pump non-aortic cross-clamping operations were performed.Mortality (p=0,547), length of hospital stay (p<0,001), prolonged ventilation times (p=0,017), duration of surgery (p<0,001), need for inotropic agents (p<0,001), blood products usage (p=0,026), chest tube drainage (p=0,024) were significantly higher in the aortic cross-clamp approach when compared to non-aortic cross-clamp approach in on-pump coronary bypasses.The usage of inotropic agents, bleeding end usage of blood products is less in the empty-beating heard group. The period of stay in the intensive care unit and hospital is shorter in the empty-beating heart group compared to cross-clamped group. However there is no significant difference in terms of mortality, stroke, pulmonary and renal complications between these two methods.
Coronary artery bypass surgery with the aid of cardiopulmonary bypass circuit can be performed in two different ways. In aortic cross-clamping method, aorta is cross-clamped, global myocardial ischemia is maintained and the anastomoses are performed with the protection of the arrested myocardium with cardioplegic solutions on a silent non-beating heart. In empty-beating heart method, aorta is not cross-clamped and the distal anastomoses are performed with the aid of a stabilizatör on the beating heart under cardiopulmonary bypass. The coronary arteries are selectively occluded and regional ischemia is performed. In this retrospective study, we aimed to compare the results of these two methods in terms of mortality and morbidity.In Uludag University Faculty of Medicine between January 2004 and January 2010, 394 on-pump aortic cross-clamping operations and 98 on-pump non-aortic cross-clamping operations were performed.Mortality (p=0,547), length of hospital stay (p<0,001), prolonged ventilation times (p=0,017), duration of surgery (p<0,001), need for inotropic agents (p<0,001), blood products usage (p=0,026), chest tube drainage (p=0,024) were significantly higher in the aortic cross-clamp approach when compared to non-aortic cross-clamp approach in on-pump coronary bypasses.The usage of inotropic agents, bleeding end usage of blood products is less in the empty-beating heard group. The period of stay in the intensive care unit and hospital is shorter in the empty-beating heart group compared to cross-clamped group. However there is no significant difference in terms of mortality, stroke, pulmonary and renal complications between these two methods.
Description
Keywords
Pompalı koroner baypas, Kros klempsiz, Kros klempli, Mortalite, Morbidite, On-pump coronary bypass, Aortic cross-clamped, Not aortic cross-clamped, Mortality, Morbidity
Citation
Türkücüoğlu, İ. (2012). Pompalı koroner arter baypaslar, kros klempli-kros klempsiz operasyonlar. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.