EARLY AND LONG TERM RESULTS OF CORONARY ARTERY
BYPASS GRAFTING IN PATIENTS WITH POOR LEFT VENTRICULAR EJECTION FRACTION
Kaplan S, Uçar H. İ, Doğan R, Demircin M, Böke E, Ersoy
Ü, Bozer A. Y, Paşaoğlu İ.
Revascularization of ischemic myocardium in patients with
impaired global left ventricular (LV) function remains a surgical challenge.
The present study retrospectively evaluates our experience with coronary
artery bypass grafting (CABG) in patients with severe left ventricular
dysfunction and evaluates whether these patients benefit from CABG by
evaluating the early and late functional results of revascularization in
these group of patients.
We retrospectively analyzed the data
of 138 patients, with a left ventricular ejection fraction (LVEF) < 35% who
underwent isolated CABG performed in our clinic during a 18-years period. In
the present study, various parameters such as preoperative clinical
characteristics of the patients, angiographic characteristics, indications
for surgery, operative data, hospital events, early and late outcome have
been reviewed and the results of CABG surgery in patients with an EF of <
35% were evaluated.
There were 138 patients (122 man ,
16 women, aged 38 to 83 years, mean 55.5-years). Preoperative mean ejection
fraction (EF) was 28.3% (range 18% to 35%). Hypertension was present in
89.7%, diabetes was present in 24.4%, hyperlipidemia was in 75.4%, smoking
history was in 72.4%, family history of coronary artery disease was in
63.0%, renal dysfunction was in 12.3%, and other vascular diseases occurred
in 15.9% of patients. History of recent myocardial infarction (MI) was
present in 42.8%, ventricular arrhythmia was in 26%, angina (stable,
unstable or post infarction) in 72%, Class III or IV congestive heart
failure (CHF) in 55.8% pulmonary edema was present in 18% of patients. There
were single-vessel disease in 12.32% of patients, double-vessel disease in
27.54%, triple-vessel disease in 60.14% and left main coronary artery (LMCA)
disease in 13.04%. Twenty of 138 patients (14.2%) were operated urgently,
and 86.8% of patients were operated electively. Indication for surgery was
CHF in 55.8% of patients, angina in 72% of patients, arrhythmias in 26% of
patients, and LMCA diseases in 13.04% of patients. Mean cross-clamp time and
CPB time were 49.91 and 81.21 minutes. The average number of bypass grafts
was 3.4. One hundred four of 138 patients (75.5%) had a LIMA graft placed to
the LAD artery. One hundred twenty-four of 138 patients (92%) had a complete
revascularization. In hospital mortality was 3.6% (5 patients). Arrhythmia
(61.8%), low cardiac output (34.8%) and MI (5.8%) was most common
postoperative complications. Mean follow-up time was 84.2 months. Mean
postoperative asymptomatic time was 62.1 months. One hundred eight of 131
surviving patients required hospitalization for cardiac or non-cardiac
reasons during the follow-up period: angina in 50.5%, arrhythmia in 19.9%,
and CHF in 12.2% were the most common reasons of hospitalization.
Forty-three patients (32.8% of 131 survivors) died during the follow-up
period: death was cardiac in 33 (25.5%) and non-cardiac in 10 (7.4%). Mean
time for postoperative EF measurement was 66 months. Mean postoperative EF
increased substantially, from 28.3% to 39.2% (p<0.0001). Mean postoperative
angina score improved from 3.02 preoperatively to 1.28 postoperatively
(p<0.001). Mean CHF score improved from 3.24 preoperatively to 1.44
postoperatively (p<0.001). Among all patients undergoing surgery, cardiac
survival (freedom from death due to cardiac cause) was 86.12% at 1 year,
82.4% at 3 years, 72.6 in 5 years and 46.1% at 10 years.
Our results suggests that in patients with coronary
artery disease and advenced LV dysfunction, CABG can be performed relatively
safe, improves left ventricular function (as reflected by improvement in
LVEF), improves the quality of life (as reflected by improvement in anginal
and CHF status), can safely utilize the LIMA as a conduit and provides a
good long-term survival. Thus, the use of CABG should be encouraged for
patients with advanced LV dysfunction and may provide a viable alternative
to transplantation in selected patients.
TIMING FOR EPICARDIAL PACE LEAD REMOVEL
USED IN PATIENTS WHO UNDERWENT OPEN HEART SURGERY
Çağlı K , Emir M, Kaplan S, Ulaş M, Bakuy V, Gürkahraman S,
Lafçı G, Korkmaz K, Gedik S, Paç M.
Determination of the most suitable postoperative time for
removal of the epicardial pace leads used in patients who underwent open
heart surgery.
Between August 2004 and October
2004, 100 patients who underwent open heart surgery were included in this
study. Patients were divided into three groups: 35 patients in 1st group
whose lead was removed in the 3rd postoperative day, 35 patients in the 2nd
group whose lead was removed in the 5th postoperative day and 30 patients in
the 3rd group whose lead was removed in the 7th postoperative day. Patient's
demographic variables and, parameters or risk factor for infection which may
increase intraoperative and postoperative infection in these patients were
evaluated.
There was no difference between the
groups in the clinical and laboratory data of infection postoperatively.
Pace lead culture was positive in only two of 100 patients evaluated, but
both of them were regarded as contamination from the skin.
Pace lead
should be removed in the patients as early as possible whose postoperative
period is uneventful.
Key Words: Epicardial pace
lead, Pace lead infection, Postoperative complications
DEMOGRAPHıC VARıABLES OF YOUNG TURKıSH ADULTS WıTH
ACUTE CORONARY SYNDROME
Yıldırım N.
In order to define the prevalence of various risk
factors, coronary anatomy, treatment modalities and early clini-cal course
of young Turkish population with acute coronary syndrome before age 40, a
retrospective study was conducted over a 2-year period.
One hundred and fifty-five cases of
initial acute coronary syndrome which were diagnosed on the basis of typical
chest pain, diagnostic electrocardiographic findings and cardiac enzyme
evolutionary patterns were reviewed.
The mean age of the patients was
35±3 years and 92.3% were male. Low levels of high-density lipoprotein and
smoking were the most important risk factors. Significant coronary heart
disease was present in most patients (87.7%). Fifty percent of patients had
single vessel disease and 5% had normal coronary angiograms. Left anterior
descending artery was most commonly involved. Most of the patients were free
of complications during hospitalization period. Percutaneous intervention or
coronary artery bypass surgery were performed approximately 57-58% of the
patients.
Our study characterized the risk
factors, coronary lesions and clinical course of acute coronary syndrome in
young Turkish population before age 40: low levels of high-density
lipoprotein and smoking were the major risk factors, a common angiographic
finding was significant single vessel disease, left anterior descending
artery was most commonly involved and early mortality and morbidity rates
were low.
Mitral valve disease is a common medical problem. Mitral
valve replacement or mitral valve repair are the current surgical options
for patients with mitral regurgitation. Mortality for first operative repair
is in the range of 2%, where as mortality for re-operation for repair is
four times that. Therefore, catheter-based strategies are being explored for
the treatment of mitral regurgitation and other valve disease. In this
article, we discuss the recent advances in surgical and percutaneous
management of mitral regurgitation.
The aged people naturally face chronic diseases including
coronary artery disease frequently. Coronary artery disease affects
approximately the 20 % of the aged patients, and is responsible from 20 %
of the morbidity and at least 50 % of the mortality. Approximately one third
of the patients who had acute myocardial infarction are older than 75 years
of age. As the population gets older this ratio increases.
Thrombolytic treatment and primary
coronary angioplasty are applied to the aged less often. It has been
decleared that the patients older than 80 years old have five times more
procedural mortality compared to the ones younger than 60 years of age. With
the development of intracoronary stents there has been a serious increase in
procedural success and decreases in procedural mortality, acute myocardial
infarction, and the frequency of emergency bypass surgery.
With the patients avareagely 80
years old when the results of medical treatment compared to coronary
angioplasty and bypass operation they are similar in mortality in 30 days
and in one year. But,the patients who have medical treatment show more
complains and have a low life quality.
Wit an aged patient, when myocardial
revascularization is necessary, percutaneous approach should be the chosen
treatment method. Surgical approach, at present, gives better results in
patients with diabetes mellitus. The development of drug-eluted stents has
changed the limits of coronary interventions. Althoug the age is a
determining factor from a view of procedural risk, this ratio shows
distinctive difference among the aged.
SURGICAL REPAIR OF DISSECTING AORTIC ANEURYSM
AFTER RENAL TRANSPLANTATION: CASE REPORT
Kaplan S, Özatik M. A, Kocabeyoğlu S. S,
Bardakçı H, Paç M.
Developments in immunosuppressive therapeutic regimens
and progression in surgical experiences have contributed significantly to
the improvement of survival rates after transplant operations. Recenly, the
number of the patients with renal transplantation has been increased.
However, patients with renal transplantation have a higher incidence of
cardiovascular disease due to hemodialysis, hypertension, or
immunosuppression, and therefore these patients can present with different
cardiovascular pathologies some needing urgent surgical interventions.
Although, there are many reports on open heart operations such as coronary
artery bypass grafting or valve replacement after renal transplantation,
there are only a few presentations of aortic dissection after renal
transplantation. A patient with DeBakey type I aortic dissection was
operated successfully 8 years after renal transplantation. It is important
to protect myocardium, renal perfusion and spinal cord during the operation,
and the right upper brachial artery cannulation is safe method for this
purpose.
STROKE AND ATRIOVENTRICULAR COMPLETE BLOCK ACCOMPANIED BY LARGE MITRAL
ANNULAR CALCIFICATION: A CASE REPORT
Soylu A, Düzenli M. A.
Mitral annular calcification is a
common pathology, especially witnessed with old age. It was suggested that
this pathology increases stroke risk and causes atrioventricular conduction
defect to some extent. In this peper, a 78-year-old female hypertensive
patient with diabetes mellitus who experienced stroke five years ago was
presented with the diagnosis of atrioventricular complete block on the
admission, and large calcification was detected in her mitral valve anulus
on her echocardiographic examination.
