Offpump ve onpump koroner arter bypass greftleme için hasta seçim kriterleri
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Dosyalar
Tarih
2014
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi Tıp Fakültesi Dergisi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada, koroner arter hastalıklarının tedavisinde off-pump ve on-pump cerrahi metodlarının, güvenilirliği, etkinliği ve teknik seçiminin nedenleri karşılaştırılmıştır.
Gereç ve Yöntemler: Mart 2003-Ocak 2013 tarihleri arasında izole KABG( Koroner Arter Baypas Greftleme) operasyonu uygulanan ardışık 540 hasta, retrospektif olarak karşılaştırıldı. On-pump metod ile tedavi edilen 270 hasta(Grup 1) ile off-pump metod ile tedavi edilen 270 hasta (Grup 2) karşılaştırıldı. On-pump metod (Grup 1) uygulanan hastaların, 215’i erkek ve 55’i kadındı ve ortalama yaş 56,3±9,3 idi. 27(%10) hastada sol ana koroner arter lezyonu tanısı kondu. Off-pump metod (Grup 2) uygulanan hastaların, 209’u erkek ve 61’i kadındı ve ortalama yaş 57,8±9,8 idi.
Bulgular: Koroner arter baypas yapılan damar sayısı grup 1’de 3,1±0,6; grup 2’de ise 2,1±0,7 idi. Bu farklılık anlamlı bulundu (p=0,016). Mekanik ventilatör desteğinde geçen süre grup 2’de daha kısa idi(p=0,0001). Grup 1’de üç ve/veya daha çok hedef damara baypas yapılan hasta sayısı, grup 2’ye göre daha fazla iken; bir ve/veya iki hedef damara baypas yapılan hasta sayısı ise, grup 2’ye göre grup 1’de daha azdı. CK-MB ve troponin I düzeyleri, grup 2’de daha düşüktü. Grup 2’deki hastaların grup 1’dekilere göre daha kısa hastanede kalış süreleri olduğu gözlendi (p=0,0001).
Sonuç: Off-pump operasyon tekniği, daha az sayıda hedef damar sayısı olan hastalarda tercih edilirken; On-pump operasyon tekniği ise diabetes mellitus(DM) tanılı, çoklu damar lezyonu olan ve sol ana koroner arter lezyonu tanısı olan hastalarda tercih edildi.
Background: This study compares safety, efficacy, and reasons of selection criteria between off-pump coronary bypass grafting (OPCAB) and conventional on-pump coronary bypass grafting (CCAB) in patients with coronary artery disease. Material and Methods: The study feeds on a retrospective, observational cohort study of data collected from 540 consecutive patients with coronary artery disease undergoing isolated CABG (coronary artery bypass grafting) (270 OPCAB , 270 CCAB) between March 2003 and January 2013. Two hundred and seventy patients who underwent surgery with on-pump method (group 1) were compared to the group of 270 patients who underwent surgery with off-pump method (group 2). Results: The mean number of anastomoses was 3.1±0.6 in group 1 and 2.1±0.7 in group 2; the difference was significant (p=0.016). The duration of mechanical ventilation support time was shorter for patients in group 2 (p=0.0001). The number of patients with three and/or four target vessel coronary artery bypasses in group 1 was substantially higher compared with the patients in group 2, while the number of patients undergoing one and/or two target vessel bypasses was substantially lower. The levels of CK-MB and troponin I were substantially lower in group 2. Group 2 patients demonstrated shorter hospital stay period than group 1 patients (p=0.0001). Conclusion: The off-pump operation technique is preferred for patients with less target vessel anastomoses, while the on-pump operation technique is preferred for the patients with diabetes mellitus, multiple coronary artery lesions, and left main coronary artery (LMCA) lesions.
Background: This study compares safety, efficacy, and reasons of selection criteria between off-pump coronary bypass grafting (OPCAB) and conventional on-pump coronary bypass grafting (CCAB) in patients with coronary artery disease. Material and Methods: The study feeds on a retrospective, observational cohort study of data collected from 540 consecutive patients with coronary artery disease undergoing isolated CABG (coronary artery bypass grafting) (270 OPCAB , 270 CCAB) between March 2003 and January 2013. Two hundred and seventy patients who underwent surgery with on-pump method (group 1) were compared to the group of 270 patients who underwent surgery with off-pump method (group 2). Results: The mean number of anastomoses was 3.1±0.6 in group 1 and 2.1±0.7 in group 2; the difference was significant (p=0.016). The duration of mechanical ventilation support time was shorter for patients in group 2 (p=0.0001). The number of patients with three and/or four target vessel coronary artery bypasses in group 1 was substantially higher compared with the patients in group 2, while the number of patients undergoing one and/or two target vessel bypasses was substantially lower. The levels of CK-MB and troponin I were substantially lower in group 2. Group 2 patients demonstrated shorter hospital stay period than group 1 patients (p=0.0001). Conclusion: The off-pump operation technique is preferred for patients with less target vessel anastomoses, while the on-pump operation technique is preferred for the patients with diabetes mellitus, multiple coronary artery lesions, and left main coronary artery (LMCA) lesions.
Açıklama
[Turgut Özal Tıp Merkezi Dergisi, (2014).21 (1)]
Anahtar Kelimeler
Off-Pump Koroner Baypas, On-Pump Koroner Bypass, Miyokardial İskemi, Off-Pump Coronary Bypass;
Kaynak
Turgut Özal Tıp Merkezi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
21
Sayı
4
Künye
Gökalp, F.,Özçınar, E.,Tiryakioğlu, O.,Kenar, S. Tiryakioğlu.,(2014).Offpump ve onpump koroner arter bypass greftleme için hasta seçim kriterleri.Turgut Özal Tıp Merkezi Dergisi, 21 (1).12-14 ss.
