| Abstract | Cilj istraživanja: Cilj ovog istraživanja je definiranje optimalnijeg kardiokirurškog pristupa bolesnicima s višežilnom koronarnom bolešću koji su zahtijevali žurnu revaskularizaciju.
Ispitanici i metode: U studiju su uključena 102 ispitanika operirana na Zavodu za kardiokirurgiju KBC-a Split u razdoblju od 1. lipnja 2013. do 1. lipnja 2017. Ispitanici su svrstani u dvije skupine s obzirom na operacijsku tehniku. Prvu skupinu činilo je 75 ispitanika operiranih na kucajućem srcu (OPCAB), a drugu 27 ispitanika operiranih na zaustavljenom srcu (CABG). Skupine su uspoređene s obzirom na preoperativne komorbiditete te ishode liječenja.
Rezultati: Ispitanici u obje skupine imali su jednako zastupljene komorbiditete te su skupine komparabilne. Statistički se eksperimentalne skupine razlikuju po razini postoperativnog troponina, mehaničkoj ventilaciji, uporabi IABP, boravku u KBC-u i smrtnosti unutar 30 dana. Razina postoperativnog troponina I prosječno je iznosila 3,561 ng/mL u OPCAB, a 15,038 ng/mL u CABG skupini (p=0,001), a razina HS troponina 3117,982 ng/L u OPCAB i 14875,63 ng/L u CABG skupini (p=0,001). Mehaničku ventilaciju kraću od 24 sata zahtijevalo je 87% ispitanika u OPCAB i 56% u CABG skupini (p<0,001), od 24 do 48 sati 5% ispitanika u OPCAB i 7% u CABG skupini (p=0,623), a dužu od 48 sati 8% ispitanika u OPCAB i 37% ispitanika u CABG skupini (p=0,001). Intraoperativna IABP upotrijebljena je u 1% ispitanika u OPCAB i 37% ispitanika u CABG skupini (p<0,001). U KBC-u je 7-15 dana boravilo 84% ispitanika u OPCAB i 45% u CABG skupini (p<0,001) i duže od 15 dana 16% ispitanika u OPCAB, te 48% ispitanika u CABG skupini (p=0,002). U OPCAB skupini, unutar 30 dana od operacije, preminulo je 3% ispitanika, a u CABG skupini 26% ispitanika (p=0,001). Ishodne varijable po kojima se skupine ne razlikuju su: prosječna transfuzija koncentrata eritrocita, boravak u JIL-u, učestalost inotropne potpore i postoperativne aritmije, prosječna razina uree i kreatinina, učestalost postoperativnog CVI-ja i potreba za revizijom. |
| Abstract (english) | Objectives: The aim of this study was to determine the best method of approaching urgent patients with multi-vessel coronary artery disease.
Patients and methods: This study involved 102 examinees who underwent urgent coronary artery bypass grafting surgery at the University Hospital of Split between July 2013 and July 2017. Examinees were divided into two groups, depending on the surgical procedure: 75 examinees were assigned to OPCAB group and 27 examinees were assigned to CABG group. Preoperative comorbidities and the outcome of the treatments were compared in the groups.
Results: Two groups had similar baseline data. Parameters that differed significantly were laboratory parameters of troponin I (3.561 ng/mL in OPCAB vs. 15.038 ng/mL in CABG group, p=0.001) and HS troponin (3117.982 ng/L in OPCAB vs. 14875.63 ng/L in CABG group, p=0.001), duration of mechanical ventilation: shorter than 24 hours (87% of examinees in OPCAB vs. 56% in CABG group, p<0.001) and longer than 48 hours (8% of examinees in OPCAB vs. 37% in CABG group, p=0.001), intraoperative use of IABP (1% of examinees in OPCAB vs. 37% in CABG group, p=0.0001), hospital stay: 7-15 days (84% of examinees in OPCAB vs. 45% in CABG group, p=0.0002) and longer than 15 days (16% of examinees in OPCAB vs. 48% in CABG group, p=0.0021) and 30-day mortality (3% of examinees in OPCAB vs. 26% in CABG group, p=0.0012). Transfusion of erythrocyte concentrates, inotropic support use, incidence of post-operative arrhytmia, post-operative stroke, level of urea, creatinine value and incidence of re-exploration were similar.
Conclusion: OPCAB technique compared to CABG technique exemplifies more optimal method of surgical coronary revascularization because it is associated with lower troponin levels, less use of IABP, shorter mechanical ventilation duration time, shorter hospital stay and lower 30-day mortality. |
