Turkiye Klinikleri Journal of Cardiovascular Surgery

Koroner Arter Cerrahisinde Radial Arter Kullanılması Peroperatif ve Erken Postoperatif Seyri Değiştirir mi?
DOES THE USE OF RADIAL ARTERY IN CORONARY BYPASS SURGERY CHANGE PEROPERATIVE AND EARLY POSTOPERATIVE COURSE?
Rıza TÜRKÖZ*, Hakan ATALAY**, Tarık KIZILTAN***, Alpay Turan SEZGİN****, Ayda TÜRKÖZ*****, Atılay TAŞDELEN******, Sait AŞLAMACI******
* Doç., Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Hastanesi Kalp Damar Cerrahisi AD, ** Op., Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Hastanesi Kalp Damar Cerrahisi AD, ***, Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Hastanesi Kalp Damar Cerrahisi AD, ****, Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Hastanesi Kardiyoloji AD, *****, Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Hastanesi Anestezi ve Reanimasyon AD, ADANA******, Başkent Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi AD, ANKARA
Turkiye Klinikleri J Cardiovascular Surgery. 2003;4(3):126-32
Article Language: TR
Full Text
ÖZET
 Amaç: Radial arter (RA) son yıllarda koroner arter cerrahisinde (KAC) kullanımı artmasına rağmen sol internal torasik arter kadar yaygın kullanım alanı bulamamıştır. Bunun en önemli sebebi RA kullanımına bağlı bazı çekincelerin mevcut olmasıdır. Bu çalışmada RA kullanılan ve kullanılmayan olgular karşılaştırıldı. Materyel ve Metod: Başkent Üniversitesi Adana Uygulama ve Araştırma Hastanesinde Şubat 2001 ile Nisan 2002 tarihleri arasında 502 olguya izole KAC uygulandı. Çalışmamızda homojen bir protokol sağlamak için tek cerrahi ekip tarafından gerçekleştirilen 254 olgu çalışmaya alındı. Bunlardan 126sında RA kullanılırken 128inde kullanılmadı. Olgular retrospektif olarak değerlendirildi. Bulgular: Yaş ortalaması RA kullanılmayanlarda belirgin olarak daha fazlaydı (p 0.05). Cins, diyabet, hipertansiyon, KOAH, periferik damar hastalığı, sol ana koroner hastalığı, reoperasyon oranı her iki grup arasında farklı değildi. Üç damar hastalığı oranı RA grubunda fazlayken tek damar hastalığı oranı RA kullanılmayanlarda fazlaydı. RA grubunda 4 hastada ejeksiyon fraksiyonu %30 altında iken diğer grupta 16 hastada (%12) mevcuttu (p 0.05). Konjestif kalp yetmezliği bulguları RA kullanılan 6 (%4) hastada, kullanılmayan 19(%14) hastada vardı (p 0.05). Operasyonda distal anastomoz sayısı RA grubunda 3.42, RA kullanılmayanlarda 2.59du (p 0.05). Pompa süresi ve aortik klemp süresi radial arter grubunda daha uzunken (p 0.05), operasyon, respiratör, yoğun bakımda kalış süreleri ve hastanede kalış zamanı her iki grup arasında farklı değildi. Hiçbir olguda iskemik el komplikasyonu görülmedi. Mortalite RA kullanılanlarda 1 hastada (%0.7), kullanılmayanlarda 2 hastada (%1.5) gözlendi ve iki grup arasındaki fark anlamlı değildi. Sonuç: Çıkarılmasına engel bir durum yoksa veya sol ventrikül fonksiyonları ileri derecede bozuk değilse RA kullanılmasını rutin olarak tercih etmekteyiz. RA kullanımı morbidite, mortalite, operasyon süresi ve hastanede kalış zamanını arttırmadığı için KACde rutin arteriyel greft olarak önermekteyiz.

Anahtar Kelimeler: Radial arter, Koroner bypass cerrahisi
ABSTRACT
 Objective: While the use of radial artery (RA) in coronary artery bypass surgery (CABG) has increased in recent years, it is still not used as widespread as the left internal thoracic artery due to some concerns related to the use of RA. In this study, we have compared the cases of CABG with and without RA. Material and Method: Between February 2001 and April 2002, 502 patients underwent coronary artery bypass grafting in the Baskent University Adana Center. To provide protocol homogenity and procedural individually, the 254 patients who underwent CABG by the same surgical team were included in this study. The patients were evaluated retrospectively; 126 of them had received RA grafts (RA group) and the rest hadnt (control group). Results: Mean age was significantly different between the groups and higher in the control (non-RA) group (p0.05). The other dermographic and clinical characteristics such as, sex, the presence of diabetes mellitus, hypertension, chronic obstructive pulmonary disease, peripheral vascular disease, left main disease, and reoperation rate were not statistically different between the groups. While the rate of multi-vessel disease was higher in the RA group, the rate of single-vessel disease was higher in the control group. Poor ejection fraction (below 30%) was higher in the control group (in 4 patients) than in the RA group (in 16 patients) (p0.05). Congestive heart failure symptoms were significantly higher in the control group (19 patients in control group and 6 patients in the RA group, p0.05). The ratio of distal anastomosis was higher in the control group than in the RA group (3.42 versus, 2.59, p0.05). While the durations of on-pump and aortic cross-clamping was higher in the RA group (p0.05), the durations of operation, the ventilatory support, postoperative stay in the intensive care unit and hospital stay were not different between the groups. The arm ischemia was not seen in any patient. Mortality was not significantly different between the RA group (in 1 patient, 0.7%) and the control group (in 2 patients, 1.5%). Conclusion: We prefer to use RA as an arterial conduit routinely in CABG unless there is any contraindication of harvesting the artery or a severe left ventricular dysfunction. We suggest using the radial artery as a routine arterial conduit in CABG as it does not increase mortality, morbidity, operation duration and hospital stay.

Keywords: Radial artery, Coronary bypass surgery

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