COMPARISON OF EARLY POSTOPERATIVE OUTCOMES IN TWO DIFFERENT SURGICAL TECHNIQUES OF COMBINED CORONARY ARTERY BYPASS GRAFTING AND AORTIC VALVE REPLACEMENT

Cilj istraživanja: Usporediti rane poslijeoperacijske ishode operacijske tehnike kombiniranog zahvata aorto-koronarnoga premoštenja i zamjene aortalnoga zalistka u kojih je koronarno premoštenje izvedeno uz ili bez potpore stroja za izvantjelesni krvotok. Ustroj istraživanja: Provedeno je povijesno prospektivno istraživanje. Mjesto istraživanja: Istraživanje je provedeno na Klinici za anesteziologiju, reanimatologiju i intenzivno liječenje Medicinskog fakulteta, Sveučilišta u Splitu, u Jedinici intenzivnog liječenja Kliničkog bolničkog centra Split. Sudionici: U istraživanje smo uključili 81 ispitanika u kojih je obavljena kombinirana operacija aorto-koronarnog premoštenja i zamjene aortalnoga zalistka u vremenskom razdoblju od 2008. do kraja 2011. godine. Glavne mjere ishoda: Bilježene su poslijeoperacijske vrijednosti s bolesničke liste Jedinice intenzivnog liječenja. Vrijeme potrebne strojne ventilacije bilježeno je u satima, vrijeme boravka u JIL-u i vrijeme potrebne inotropne potpore u danima, a količina krvarenja na prsni dren i količina transfudiranih krvnih pripravaka u mililitrima (mL). Rezultati: Prijeoperacijska obilježja ispitanika bila su slična u obje skupine. Životna dob ispitanika operiranih uz cjelovremenu potporu stroja za izvantjelesni krvotok bila je 68,8±8,5 godina, a dob ispitanika u kojih je koronarno premoštenje izvedeno bez potpore stroja za izvantjelesnu cirkulaciju iznosila je 71,1±6,2 godine. Muškarci su bili brojniji u obje skupine ispitanika. Boravak u jedinici intenzivnog liječenja nije se značajno razlikovao među skupinama (P=0,554). Vrijeme provedeno na mehaničkoj ventilaciji razlikovalo se među skupinama (P=0,044). Skupina CABG na ventilatoru je bila 19,6±5,2 sata, a skupina OPCABG je na ventilatoru bila 17,5±3,7 sata. Potreba za inotropnom potporom nije se bitno razlikovala među skupinama (P=0,462), kao ni krvarenje na prsne drenove (P=0,298). Bolesnici operirani tehnikom CABG primili su 828,3±539,2 mL koncentriranih eritrocita, a bolesnici operirani tehnikom OPCABG 680,9±559,4 mL (P=0,209). Jedino je postojala značajna razlika vremena provedenog na mehaničkoj ventilaciji. Ostale razlike poslijeoperacijskih obilježja nisu statistički značajne. Zaključci: Operacije kombiniranog koronarnog premoštenja i zamjene aortalnoga zalistka u kojima je aorto-koronarno premoštenje izvedeno bez uporabe stroja za izvantjelesni krvotok ne razlikuju se od operacija izvedenih uz cjelovremenu uporabu stroja za izvantjelesni krvotok izuzev vremena trajanja mehaničke ventilacije. Potreba za mehaničkom ventilacijom značajno je bila kraća u skupini ispitanika u kojih je koronarno premoštenje prvo izvedeno bez potpore stroja za izvantjelesni krvotok, a potom je zahvat na aortalnomu zalistku nastavljen uz potporu stroja za izvantjelesni krvotok.Objective: To compare early postoperative outcomes of surgical techniques of combined aorto-coronary bypass grafting and aortic valve replacement in whom coronary artery bypass grafting was performed with or without the support of the heart lung machine. Design: Historical prospective study. Settings: The study was conducted in Department of Anesthesiology, Resuscitation and Intensive Tretment of University of Split School of Medicine in the Intensive Care Unit of the Clinical Hospital Centre of Split. Participants: The study included 81 patients who underwent combined aorto-coronary bypass grafting and aortic valve replacement in the period from 2008 to the end of 2011. Main Outcome Measures: Postoperative values were recorded from a patients list of the intensive care unit. We compared length of stay in intensive care unit (days), ventilation time (hours), postoperative blood loos on the chest drain and need for transfusion (mL), and postoperative inotropic support (days). Results: Preoperative characteristics of patients were similar in both groups. Age of patients treated with the support of the heart lung machine during coronary artery bypass grafting was 68.8±8.5 years, and age of patients in whom coronary artery bypass grafting was performed without the support of the machine for extracorporeal circulation was 71.1±6.2 years. Men were more numerous in both groups. The duration of ICU stay was not significantly different between groups (P=0.554). The time spent on mechanical ventilation differed between groups (P=0.044). CABG group spent on the ventilator 19.6±5.2 hours, and OPCABG group was on the ventilator 17.5±3.7 hours. The need for inotropic support did not significantly differ between groups (P=0.462), or bleeding in the chest drains (P=0.298). The CABG group recived 828.3±539.2 mL of concentrated red cells, and OPCABG patients recived 680.9±559.4 mL (P=0.209). There was only a significant difference in time spent on mechanical ventilation. Other features of the postoperative outcomes were not statistically significant. Conclusion: Combined coronary bypass surgery and aortic valve replacement in whom coronary artery bypass grafting was performed without using the heart lung machine does not differ from operation performed with the use of heart lung machine during coronary artery bypass, except for duration of mechanical ventilation. The need for mechanical ventilation was significantly shorter in the group of patients in whom coronary bypass grafting was performed without the support of the heart lung machine, and then aortic valve replacement continued with the support of the heart lung machine