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Effects of Left Internal Thoracic Artery Graft Use on Coronary Artery Bypass Grafting Mortality and Morbidity in Octogenarians

Yıl 2018, Cilt: 21 Sayı: 2, 135 - 142, 19.08.2018

Öz

Introduction:
Atherosclerotic
heart disease is the leading cause of death in developed countries. In our
country, the numbers are slightly lower, but increase each year. In 2008, the
number of cases was 10.410 (12.03%) of all deaths among people aged 75 and
over. The proportion of octogenarians undergoing cardiac surgery is increasing,
although this high risk population has many unknown issues to decrease
mortality and morbidity.The aim of this study was to understand and compare the
role of left internal thoracic artery (LITA) versus saphenous vein (SVG) to
left anterior descending artery (LAD) grafting on early- and mid-term results.



Patients
and Methods:
A retrospective analysis was conducted on 105 consecutive
patients who were 80 years of age or older and who underwent isolated coronary
artery bypass grafting (CABG) between January 2000 and January 2010. Patients
with saphenous venous graft only (SVG; n: 27) were compared with those
receiving arterial (LITA; n: 78) and saphenous venous grafts. Mean follow-up
was 42.95 ± 23.36 months.



Results: There was
no significant difference in mortality and morbidity between the groups (p>
0.05). A longer duration of aortic cross-clamping was found to be associated
with postoperative renal failure in patients with saphenous venous grafts
(p< 0.05). There was no statistically significant difference in 8-year
survival rates between the groups (p> 0.05).



Conclusion: In conclusion,
octogenarians should receive complete revascularization with short aortic
cross-clamp time. We could not demonstrate the importance of graft choice for
long-term functional outcome and survival as a prognostic factor in this age
group who underwent coronary artery bypass surgery. 

Kaynakça

  • 1. Yaş grubu ve cinsiyete göre yıl ortası nüfus projeksiyonları. Available from: www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=244 (Accessed date: January 1, 2013).
  • 2. Nüfus artış hızı tahminleri ve projeksiyonları, 1986-2025. Available from: www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=243 (Accessed date: January 1, 2013).
  • 3. Beklenen yaşam süresi tahminleri. Available from: www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=1218 (Accessed date: November 2011).
  • 4. The TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary- artery disease (TIME): a randomised trial. Lancet 2001;358:951-7.
  • 5. Graham MM, Ghali WA, Faris LP, Galbraith PD, Norris CM, Knudtson ML. Survival after coronary revascularization in the elderly. Circulation 2002;105:2378-84.
  • 6. Edwards FH, Clark RE, Schwarz M. Impact of internal mammary artery conduits on operative mortality in coronary revascularization. Ann Thorac Surg 1994;57:2732.
  • 7. Leavitt BJ, OConnor GT, Olmstead EM, Morton JR, Maloney CT, Dacey LJ, et al. Use of the internal mammary artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery. Circulation 2001;103:507-12.
  • 8. Pierri MD, Capestro F, Zingaro C, Torracca L. The changing face of cardiac surgery patients: an insight into a Mediterranean region. Eur J Cardiothorac Surg 2010;38:407-13.
  • 9. Kurlansky PA, Williams DB, Traad EA, Carrillo RG, Schor JS, Zucker M, et al. Arterial grafting results in reduced operative mortality and enhanced long-term quality of life in octogenarians. Ann Thorac Surg 2003;76:418-27.
  • 10. Mery CM. TSRA rewiev of CTS. 1st ed. USA: 2011:42-4.
  • 11. Moon MR, Sundt TM, Pasque MK, Barner HB, Gay WA Jr, Damiano RJ Jr. Influence of internal mammary artery grafting and completeness of revascularization on long-term outcome in octogenarians. Ann Thorac Surg 2001;72:2003-7.
  • 12. Johansson BL, Souza DS, Bodin L, Filbey D, Loesch A, Geijer H, et al. Slower progression of atherosclerosis in vein graft sharvested with ‘no touch’ technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study. Eur J Cardiothorac Surg 2010;38:414-9.
  • 13. TÜİK. Ölüm istatistikleri. Türkiye, 2008:13-146.
  • 14. Onat A, et. al. www.TEKHARF.org/2009.html (Accessed date: November 23, 2011).
  • 15. Rohde SL, Baker RA, Tully PJ, Graham S, Cullen H, Knight JL. Preoperative and intraoperative factors associated with long-term survival in octogenarian cardiac surgery patients. Ann Thorac Surg 2010;89:105-11.
  • 16. Ivert T, Lindblom D, Welti R. Coronary artery bypass grafting in patients 70 years of age and older. Early and late results. Eur J Cardiothorac Surg 1989;3:52-7.
  • 17. Data analyses of the STS National Cardiac Surgery Database (the eighth year, January 1999). The Society of Thoracic Surgeons. Available from: http://www.sts.org. (Accessed date: March 20, 2001).
  • 18. Toker ME, Mataracı İ, Çalışkan A, Eren E, Erdoğan HB, Zeybek R, et al. Seksen yaş ve üzerindeki hasta nüfusunda açık kalp cerrahisi ameliyatları ve sonuçları. Türk Göğüs Kalp Damar Cer Derg 2009;17:151-6.
  • 19. Ferguson TB Jr, Coombs LP, Peterson ED. Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement? J Thorac Cardiovasc Surg 2002;123:869-80.
  • 20. Basaran M, Selimoglu O, Ozcan H, Ogus H, Kafali E, Ozcelebi C, et al. Being an elderly woman: is it a risk factor for morbidity after coronary artery bypass surgery? Eur J Cardiothorac Surg 2007;32:58-64.
  • 21. Ngaage DL, Cowen ME, Cale AR. Cardiopulmonary bypass and left ventricular systolic dysfunction impact operative mortality differently in elderly and young patients. Eur J Cardiothorac Surg 2009;35:235-40.
  • 22. Naughton C, Feneck RO, Roxburgh J. Early and late predictors of mortality following on-pump coronary artery bypass graft surgery in the elderly as compared to a younger population. Eur J Cardiothorac Surg 2009;36:621-7.
  • 23. Kirali K, Rabus MB, Yakut N, Toker ME, Erdogan HB, Balkanay M, et al. Early- and long-term comparison of the on- and off-pump bypass surgery in patients with left ventricular dysfunction. Heart Surg Forum 2002;5:177-81.
  • 24. Collins SM, Brorsson B, Svenmarker S, Kling PA, Aberg T. Medium-term survival and quality of life of Swedish octogenarians after open-heart surgery. Eur J Cardiothorac Surg 2002;22:794-801.

Seksenli Yaş Grubunda Koroner Baypasta Sol İnternal Torasik Arter Grefti Kullanımının Mortalite ve Morbiditeye Etkisi

Yıl 2018, Cilt: 21 Sayı: 2, 135 - 142, 19.08.2018

Öz

Giriş: Aterosklerotik kalp hastalığı gelişmiş ülkelerde en
önemli ölüm nedenidir. Ülkemizde de giderek artan bir yüzdeyle mortalitede üst
sıralarda bulunmaktadır. 2008 yılında 75 yaş üstü nüfusun %12.03’ünde ölüm
nedeninin iskemik kalp hastalığı olduğu saptanmıştır. Kalp cerrahisinde giderek
artan bir yüzdeye sahip olan seksenli yaş grubunda operatif mortalite ve
morbiditeyi azaltmak için araştırılması gereken pek çok başlık mevcuttur.
Çalışmamızda koroner arter baypas greft (CABG) yapılan seksenli yaş grubu
hastalarda sol ön inen koroner arter baypasında safen ven (SVG) veya sol
internaltorasik arter grefti (LITA) seçiminin erken ve orta dönem mortalite
açısından rolünü araştırdık.



Hastalar ve Yöntem: Ocak 2000-Ocak 2010 yılları
arasında izole CABG operasyonu uygulanmış seksenli yaş grubunda 105 hasta
çalışmaya dahil edilerek retrospektif olarak incelendi. LITA kullanılan
[LITAgrubu (n: 78)] ve kullanılmayan [SVG grubu (n: 27)] hastalar kıyaslandı.
Ortalama takip süresi 42.95 ± 23.36 aydı.



Bulgular: Mortalite ve morbidite açısından her iki grup arasında
istatistiksel anlamlı fark izlenmedi (p> 0.05). SVG grubunda uzun aortik
kros klemp süresi ile postoperatif renal yetmezlik arasında ilişki olduğu
bulundu (p< 0.05). Sekiz yıllık takipte hayatta kalım açısından her iki grup
arasında istatistiksel fark yoktu (p> 0.05).



Sonuç: Seksenli yaş grubu
hastalarda beklenen kısa yaşam sürelerine rağmen komplet revaskülarizasyon ve
kısa aortik kros klemp süresi ile CABG başarıyla uygulanabilir. Bizim
çalışmamızda LITA kullanımı mortaliteye etkili bulunmamıştır.

Kaynakça

  • 1. Yaş grubu ve cinsiyete göre yıl ortası nüfus projeksiyonları. Available from: www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=244 (Accessed date: January 1, 2013).
  • 2. Nüfus artış hızı tahminleri ve projeksiyonları, 1986-2025. Available from: www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=243 (Accessed date: January 1, 2013).
  • 3. Beklenen yaşam süresi tahminleri. Available from: www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=1218 (Accessed date: November 2011).
  • 4. The TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary- artery disease (TIME): a randomised trial. Lancet 2001;358:951-7.
  • 5. Graham MM, Ghali WA, Faris LP, Galbraith PD, Norris CM, Knudtson ML. Survival after coronary revascularization in the elderly. Circulation 2002;105:2378-84.
  • 6. Edwards FH, Clark RE, Schwarz M. Impact of internal mammary artery conduits on operative mortality in coronary revascularization. Ann Thorac Surg 1994;57:2732.
  • 7. Leavitt BJ, OConnor GT, Olmstead EM, Morton JR, Maloney CT, Dacey LJ, et al. Use of the internal mammary artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery. Circulation 2001;103:507-12.
  • 8. Pierri MD, Capestro F, Zingaro C, Torracca L. The changing face of cardiac surgery patients: an insight into a Mediterranean region. Eur J Cardiothorac Surg 2010;38:407-13.
  • 9. Kurlansky PA, Williams DB, Traad EA, Carrillo RG, Schor JS, Zucker M, et al. Arterial grafting results in reduced operative mortality and enhanced long-term quality of life in octogenarians. Ann Thorac Surg 2003;76:418-27.
  • 10. Mery CM. TSRA rewiev of CTS. 1st ed. USA: 2011:42-4.
  • 11. Moon MR, Sundt TM, Pasque MK, Barner HB, Gay WA Jr, Damiano RJ Jr. Influence of internal mammary artery grafting and completeness of revascularization on long-term outcome in octogenarians. Ann Thorac Surg 2001;72:2003-7.
  • 12. Johansson BL, Souza DS, Bodin L, Filbey D, Loesch A, Geijer H, et al. Slower progression of atherosclerosis in vein graft sharvested with ‘no touch’ technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study. Eur J Cardiothorac Surg 2010;38:414-9.
  • 13. TÜİK. Ölüm istatistikleri. Türkiye, 2008:13-146.
  • 14. Onat A, et. al. www.TEKHARF.org/2009.html (Accessed date: November 23, 2011).
  • 15. Rohde SL, Baker RA, Tully PJ, Graham S, Cullen H, Knight JL. Preoperative and intraoperative factors associated with long-term survival in octogenarian cardiac surgery patients. Ann Thorac Surg 2010;89:105-11.
  • 16. Ivert T, Lindblom D, Welti R. Coronary artery bypass grafting in patients 70 years of age and older. Early and late results. Eur J Cardiothorac Surg 1989;3:52-7.
  • 17. Data analyses of the STS National Cardiac Surgery Database (the eighth year, January 1999). The Society of Thoracic Surgeons. Available from: http://www.sts.org. (Accessed date: March 20, 2001).
  • 18. Toker ME, Mataracı İ, Çalışkan A, Eren E, Erdoğan HB, Zeybek R, et al. Seksen yaş ve üzerindeki hasta nüfusunda açık kalp cerrahisi ameliyatları ve sonuçları. Türk Göğüs Kalp Damar Cer Derg 2009;17:151-6.
  • 19. Ferguson TB Jr, Coombs LP, Peterson ED. Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement? J Thorac Cardiovasc Surg 2002;123:869-80.
  • 20. Basaran M, Selimoglu O, Ozcan H, Ogus H, Kafali E, Ozcelebi C, et al. Being an elderly woman: is it a risk factor for morbidity after coronary artery bypass surgery? Eur J Cardiothorac Surg 2007;32:58-64.
  • 21. Ngaage DL, Cowen ME, Cale AR. Cardiopulmonary bypass and left ventricular systolic dysfunction impact operative mortality differently in elderly and young patients. Eur J Cardiothorac Surg 2009;35:235-40.
  • 22. Naughton C, Feneck RO, Roxburgh J. Early and late predictors of mortality following on-pump coronary artery bypass graft surgery in the elderly as compared to a younger population. Eur J Cardiothorac Surg 2009;36:621-7.
  • 23. Kirali K, Rabus MB, Yakut N, Toker ME, Erdogan HB, Balkanay M, et al. Early- and long-term comparison of the on- and off-pump bypass surgery in patients with left ventricular dysfunction. Heart Surg Forum 2002;5:177-81.
  • 24. Collins SM, Brorsson B, Svenmarker S, Kling PA, Aberg T. Medium-term survival and quality of life of Swedish octogenarians after open-heart surgery. Eur J Cardiothorac Surg 2002;22:794-801.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Araştırmalar
Yazarlar

Mehmet Kalender

Serpil Taş Bu kişi benim

Mehmet Taşar Bu kişi benim

Taylan Adademir Bu kişi benim

Hasan Sunar Bu kişi benim

Yayımlanma Tarihi 19 Ağustos 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 21 Sayı: 2

Kaynak Göster

Vancouver Kalender M, Taş S, Taşar M, Adademir T, Sunar H. Effects of Left Internal Thoracic Artery Graft Use on Coronary Artery Bypass Grafting Mortality and Morbidity in Octogenarians. Koşuyolu Heart Journal. 2018;21(2):135-42.