Comparison of early results of surgical myocardial revascularization with and without the use of the machine for extracorporeal circulation

Ciljevi istraživanja: Utvrditi ukupni broj pacijenata, broj planiranih i učinjenih premoštenja, zastupljenost pojedine metode, ispitati postoje li razlike u predoperativnim rizičnim čimbenicima i poslijeoperativnim komplikacijama ovisno o primjenjenoj kirurškoj metodi. Nacrt studije: Istraživanje je retrospektivno. Ispitanici i metode: Pregled literature, prikupljanje i bilježenje podataka iz medicinske dokumentacije, obrada i interpretacija dobivenih rezultata svih pacijenata podvrgnuti kirurškoj revaskularizaciji miokarda u Kliničkom bolničkom centru u Osijeku na Odjelu za kardijalnu kirurgiju od 1. siječnja 2010. do 31. prosinca 2014. godine. Rezultati: Od ukupno je 827 ispitanika, 611 bilo je muškog spola, 216 ženskog. Veći broj ispitanika (78,7 %) operiran je s uporabom stroja za izvantjelesni krvotok. Najvećem broju ispitanika (49,0 %) učinjene su tri premosnice. Medijan dobi za sve operirane bio je 64, medijan EuroSCORE-a 4, medijan logističkog modela EuroSCORE-a 3, a medijan izbačajne frakcije 55. Pri usporedbi rizičnih faktora (dob, spol, EuroSCORE, logistički model EuroSCORE-a, izbačajna frakcija) između dviju operacijskih metoda, postojala je statistički značajna razlika. Kada se radilo o hitnim operacijama i potrebi za većim brojem premosnica, izbor je bila metoda s primjenom stroja. Nije postojala statistički značajna razlika u predoperativnom postavljanju IABP-a, poslijeoperativnom smrtnom ishodu i ICV-u među metodama. Postojala je statistički značajna razlika u poslijeoperativnom infarktu miokarda, s većom pojavnošću kod metode s uporabom stroja. Zaključak: Češće je primjenjivana kirurška revaskularizacija s uporabom stroja za izvantjelesni krvotok. Znatno lošije vrijednosti rizičnih čimbenika imali su pacijenti operirani bez uporabe stroja, a od poslijeoperativnih rezultata postojala je statistički značajna razlika samo u poslijeoperativnom infarktu.A comparison between early results of surgical myocardial revascularization with and without the use of a machine for extracorporeal circulation. OBJECTIVES: To determine the total number of patients, planned and executed bypasses, and procedures using each method in order to identify whether there is a difference in preoperative risk factors and postoperative complications according to the applied surgical technique. STUDY DESIGN: Retrospective study. PARTICIPANTS AND METHODS: Methods used included reviewing literature, gathering and recording data from medical documentation, processing and interpreting the results from all of the patients who underwent surgical myocardial revascularization at the department for cardial surgery at Clinical Hospital Center Osijek between 1 January 2010 and 31 December 2014. RESULTS: Of the total of 827 participants, 611 of them were male and 216 were female. A greater number of participants (78.7%) were operated on with the help of the machine for extracorporeal circulation. Triple bypasses were performed on a large portion of participants (49.0%). The median age for all operated patients was 64, EuroScore median was 4, logistic score median was 3, and the ejection fraction median was 55. While comparing risk factors (age, gender, EuroScore, logistic score, ejection fraction) between the two operational techniques, a statistically significant difference was found. When there was an urgent operation, and a need for a greater number of bypasses, the technique of choice was on-pump coronary artery bypass grafting. Statistically significant difference was not found between the reviewed techniques, in preoperative placing of the intra-aortic balloon pump, postoperative mortality, or ICV. A significant statistical difference was found in postoperative MI with a greater incidence associated with the on-pump CABG technique. CONCLUSION: The on-pump CABG technique for surgical myocardial revascularization was applied more often. Patients operated on with the off-pump technique had significantly detrimental risk factor values, and the only statistically significant difference in postoperative results was found in postoperative MI