Koroner arter baypas cerrahisinde kullanılan radial arter konduitin orta-uzun dönem açıklık oranları
Middle to long term patency rates of radial artery grafts in coronary artery bypass surger
- Tez No: 242323
- Danışmanlar: PROF. DR. AHMET TURAN YILMAZ
- Tez Türü: Tıpta Uzmanlık
- Konular: Göğüs Kalp ve Damar Cerrahisi, Thoracic and Cardiovascular Surgery
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2006
- Dil: Türkçe
- Üniversite: GATA
- Enstitü: Haydarpaşa Eğitim Hastanesi
- Ana Bilim Dalı: Kalp ve Damar Cerrahisi Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 82
Özet
In the early ages of aortacoronary bypass surgery only greft employed was the saphenous vein however internal mammarian artery graft is currently accepted as the gold standart choice owing to its superior long term patency rates. As complex arterial revascularization gained popularity within time, new arterial conduits such as radial artery grafts were taken in to modern surgical era. Among the arterial grafts, radial artery has many advantages and is the most frequently preferred one excluding LIMA. In this study we aimed to investigate the middle to-long term patency rates of radial artery grafts in coronary artery bypass surgery.One hundred twenty-four patients operated at Gulhane Military Medical Academy Haydarpaşa Training Hospital, Department of Cardiovascular Surgery, between November 2003 and May 2006, were included in the study as Group I. Group II included one hundred forty patients to whom grafted by saphenous vein graft and the other grafts except radial artery graft. All of the patients were operated by the same surgical team. Totally, 131 distal bypass were performed in Group I in which radial artery graft was used in each case in addition to the LIMA, RIMA and SVG applied to 115, 8 and 81 patients, respectively. Saphenous vein grafted in all of the patients in Group II additionally with LIMA and RIMA apllied to the 115 and 6 patients, respectively. Radial artery was grafted to circumflex coronary artery and right coronary artery of the patients with the rates of 49.1% and %33, respectively. Proximal anostomose of RA was applied to the aorta, SVG and LIMA with 94, 20 and 10 patients, respectively. Composite graft technique was applied totally in 30 patients. Sequential anostomose technique was used in seven of RA grafts and thus revascularization of more than one vessel was achieved. In four LAD and three RCA were endarterectomized of which vessel lumen was not suitable for anostomose. In Group II LIMA and RIMA was used in 116 and 6 cases, respectively. There was not anyviistatistically significance between the data related to the operation in both groups. ( p>0.05)In comparison of data related to the period in ıntensive care unit (mean extubation duration, mean duration of intensive care unit, mean drainage, mean blood and plasma transfusion) there was not any statistically significance between groups. ( p>0.05)Three deaths occured during the follow up period. The morbidity was 24% (n=33) in Group I, totally. The most encountered morbidity was pleural effusion, postoperatively. Of the seven patients (5.4%) two patients were treated by thoracentesis and the remain were treated medically. No neurological complication was encountered. In 15 patients (12%) atrial fibrillation was developed. All of the patients were farmacologically converted to the sinus rhythm. In seven patients all having diabetes mellitus had sternotomy skin revision, and in two patients saphenectomy incision was revised. Numbness of radial nerve area (dorsally thenar area) was developed in two patients. But no wound complication due to radial artery preparation was encountered on the related arm. In Group II morbidity was developed on 38 patients totally. In Group II, atrial fibrillation was more frequent than Group I. Neurologically, hemiplegia was developed in one patient. Two patients were treated because of gastrointestinal hemorraghe.Rate of asymptomatic patient was 84% in Group I. Control coronary angiography was performed with 20 patients. Whereas two of those patients were asymptomatic, eighteen patients underwent coronary angiography because of nonspesific symptoms positive exercise stress test. Probable ischemia was evaluated and ruled out with myocardial perfusion scintigraphy test in the asymptomatic group. Twenty radial arteries, totally 46 graft, was evaluated. Seventeen of twenty radial arteries were patent, two were occluded. In one radial artery string sign was detected and accepted as occluded. Patency rates of grafts were postoperatively evaluated after the mean period of 17.3 month. Mean patency rates of LIMA, RA, SVG and RIMA were 89.6%, 85.2%, 71.4% and 100%, respectively. Radial artery had the most patency rate in the right coronary system. The patency rates in theviiicircumflex system and diagonale system were 92% and 75%, respectively. We found the results of circumflex system more realistic than the others. Because RA graft evaluated angiographically was seventeen in circumflex system whereas RA in the right coronary system was only two. Of two patients operated 3 and 3.5 years ago angioplasty and stent implantation was performed to lesions developed in the right coronary system. The other patients were followed medically. Of the 140 patients in Group II, 28 patients were performed control coronary angiography. Of the patients performed angiography three of patients were asymptomatic, whereas twenty five patients had nonspesific symptoms and positive exercise stres test. Patency rate of IMA in the saphenous vein graft group detected angiographically at postoperative 19.6 month was 89.2%. Patency rate of saphenous vein anostomosed at circumflex system, right coronary system and diagonale system were 61.1%, 84.2% and 60%, respectively. Patency rate of all saphenous vein grafts was 70.2%, totally. One patient, operated four years ago, with the lesion newly developed in the saphenous vein graft anastomosed to right coronary system was performed angioplasty and stent implanted. Other patients followed medically.In the conclusion, patency of IMA, RA, SVG detected angiographically at moderate to long term was 89%, 85% and 71%, respectively. Patency rates of SVG detected in the last decades were found to be higher than past similar to the findings of recent studies. Statins, antihypertensive and antitrombosit drugtherapy used in the prevention of atherosclerosis has the main role in those recent high patency rates of SVG.The right coronary system has the highest patency rates among the target vessels that the radial artery anastomosed however the number of RA graft evaluated angiographically was not enough. Thus patency rate of 92% detected in the circumflex system was more realistic. As proved angiographically patency rate of radial artery graft was not better than the IMA had whereas ıt was superior to the saphenous vein graft. When we take ixin consider increasing full arterial revascularization tendency, radial artery will going to be the secondary gold standart conduit after LIMA.Keywords : Patency, Radial artery grafts, Coronary artery bypass
Özet (Çeviri)
In the early ages of aortacoronary bypass surgery only greft employed was the saphenous vein however internal mammarian artery graft is currently accepted as the gold standart choice owing to its superior long term patency rates. As complex arterial revascularization gained popularity within time, new arterial conduits such as radial artery grafts were taken in to modern surgical era. Among the arterial grafts, radial artery has many advantages and is the most frequently preferred one excluding LIMA. In this study we aimed to investigate the middle to-long term patency rates of radial artery grafts in coronary artery bypass surgery.One hundred twenty-four patients operated at Gulhane Military Medical Academy Haydarpaşa Training Hospital, Department of Cardiovascular Surgery, between November 2003 and May 2006, were included in the study as Group I. Group II included one hundred forty patients to whom grafted by saphenous vein graft and the other grafts except radial artery graft. All of the patients were operated by the same surgical team. Totally, 131 distal bypass were performed in Group I in which radial artery graft was used in each case in addition to the LIMA, RIMA and SVG applied to 115, 8 and 81 patients, respectively. Saphenous vein grafted in all of the patients in Group II additionally with LIMA and RIMA apllied to the 115 and 6 patients, respectively. Radial artery was grafted to circumflex coronary artery and right coronary artery of the patients with the rates of 49.1% and %33, respectively. Proximal anostomose of RA was applied to the aorta, SVG and LIMA with 94, 20 and 10 patients, respectively. Composite graft technique was applied totally in 30 patients. Sequential anostomose technique was used in seven of RA grafts and thus revascularization of more than one vessel was achieved. In four LAD and three RCA were endarterectomized of which vessel lumen was not suitable for anostomose. In Group II LIMA and RIMA was used in 116 and 6 cases, respectively. There was not anyviistatistically significance between the data related to the operation in both groups. ( p>0.05)In comparison of data related to the period in ıntensive care unit (mean extubation duration, mean duration of intensive care unit, mean drainage, mean blood and plasma transfusion) there was not any statistically significance between groups. ( p>0.05)Three deaths occured during the follow up period. The morbidity was 24% (n=33) in Group I, totally. The most encountered morbidity was pleural effusion, postoperatively. Of the seven patients (5.4%) two patients were treated by thoracentesis and the remain were treated medically. No neurological complication was encountered. In 15 patients (12%) atrial fibrillation was developed. All of the patients were farmacologically converted to the sinus rhythm. In seven patients all having diabetes mellitus had sternotomy skin revision, and in two patients saphenectomy incision was revised. Numbness of radial nerve area (dorsally thenar area) was developed in two patients. But no wound complication due to radial artery preparation was encountered on the related arm. In Group II morbidity was developed on 38 patients totally. In Group II, atrial fibrillation was more frequent than Group I. Neurologically, hemiplegia was developed in one patient. Two patients were treated because of gastrointestinal hemorraghe.Rate of asymptomatic patient was 84% in Group I. Control coronary angiography was performed with 20 patients. Whereas two of those patients were asymptomatic, eighteen patients underwent coronary angiography because of nonspesific symptoms positive exercise stress test. Probable ischemia was evaluated and ruled out with myocardial perfusion scintigraphy test in the asymptomatic group. Twenty radial arteries, totally 46 graft, was evaluated. Seventeen of twenty radial arteries were patent, two were occluded. In one radial artery string sign was detected and accepted as occluded. Patency rates of grafts were postoperatively evaluated after the mean period of 17.3 month. Mean patency rates of LIMA, RA, SVG and RIMA were 89.6%, 85.2%, 71.4% and 100%, respectively. Radial artery had the most patency rate in the right coronary system. The patency rates in theviiicircumflex system and diagonale system were 92% and 75%, respectively. We found the results of circumflex system more realistic than the others. Because RA graft evaluated angiographically was seventeen in circumflex system whereas RA in the right coronary system was only two. Of two patients operated 3 and 3.5 years ago angioplasty and stent implantation was performed to lesions developed in the right coronary system. The other patients were followed medically. Of the 140 patients in Group II, 28 patients were performed control coronary angiography. Of the patients performed angiography three of patients were asymptomatic, whereas twenty five patients had nonspesific symptoms and positive exercise stres test. Patency rate of IMA in the saphenous vein graft group detected angiographically at postoperative 19.6 month was 89.2%. Patency rate of saphenous vein anostomosed at circumflex system, right coronary system and diagonale system were 61.1%, 84.2% and 60%, respectively. Patency rate of all saphenous vein grafts was 70.2%, totally. One patient, operated four years ago, with the lesion newly developed in the saphenous vein graft anastomosed to right coronary system was performed angioplasty and stent implanted. Other patients followed medically.In the conclusion, patency of IMA, RA, SVG detected angiographically at moderate to long term was 89%, 85% and 71%, respectively. Patency rates of SVG detected in the last decades were found to be higher than past similar to the findings of recent studies. Statins, antihypertensive and antitrombosit drugtherapy used in the prevention of atherosclerosis has the main role in those recent high patency rates of SVG.The right coronary system has the highest patency rates among the target vessels that the radial artery anastomosed however the number of RA graft evaluated angiographically was not enough. Thus patency rate of 92% detected in the circumflex system was more realistic. As proved angiographically patency rate of radial artery graft was not better than the IMA had whereas ıt was superior to the saphenous vein graft. When we take ixin consider increasing full arterial revascularization tendency, radial artery will going to be the secondary gold standart conduit after LIMA.Keywords : Patency, Radial artery grafts, Coronary artery bypass
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