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Koronarchirurgische Rezidivoperationen mit und ohne extrakorporaler Zirkulation

Redo coronary surgery with and without cardiopulmonary bypass

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Koronarchirurgische Rezidivoperationen sind weiterhin mit einer erhöhten Mortalität verbunden. Wesentlicher Punkt für eine erfolgreiche Rezidivoperation bei Anwendung der extrakorporalen Zirkulation (EKZ) ist eine suffiziente Myokardprotektion. Die Anwendung von Off–Pump–Methoden erscheint bei Rezidivoperation eine attraktive Alternative da mögliche Nebenwirkungen der EKZ vermieden werden. Ziel der vorliegenden retrospektiven Studie war der Vergleich von EKZ und der Off–Pump–Technik bei isolierten koronarchirurgischen Rezidivoperationen.

Retrospektiv analysiert und verglichen wurden prä–, intra–, und postoperative Daten von 195 Patienten bei denen im Zeitraum von 1/98–4/ 2004 ein isolierter koronarchirurgischer Rezidiveingriff durchgeführt wurde. Bei 160 Patienten wurde der Eingriff unter Anwendung der EKZ und antegrader Myokardprotektion durchgeführt, bei 35 Patienten wurde mittels Off–Pump–Technik eine Bypassversorgung durchgeführt.

Die Morbidität und Mortalität in beiden Gruppen war vergleichbar (3,9% in der EKZ–Gruppe und 2,9% in der Off–Pump–Gruppe, p = 0,9). In der EKZ–Gruppe war die Anzahl von komplett revaskularisierten Patienten mit 86,9% (n = 139) signifikant höher als in der Off–Pump–Gruppe mit 48,6% (n=17). Entsprechend größer war die Anzahl der Bypässe (2,8 ± 0,8 vs. 1,6 ± 0,6; p = 0,048). Im weiteren Beobachtungszeitraum verstarben 20 weitere Patienten (12,5%) der EKZ–Gruppe und drei Patienten (8,6%) in der Off–Pump–Gruppe.

Koronarchirurgische Rezidivoperation können sowohl mit Anwendung der EKZ als auch als Off–Pump–Operation sicher und mit geringer Mortalität und Morbidität durchgeführt werden können. Die Off–Pump– Technik scheint durch eine höhere Rate von inkompletter Revaskularisation limitiert.

Summary

Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality compared to primary operation. Myocardial protection is one of the key issues in redo on pump CABG. Off pump redo CABG seems to be an alternative as morbidity which is associated with cardiopulmonary bypass (CPB) is avoided. The aim of this retrospective study was to compare the outcome of redo CABG with and without cardiopulmonary bypass.

From 1/98–5/2004 redo–CABG was performed in 195 patients (pts): 162 male (83.1%) and 33 female (16.9%) pts, age 66±9 years. In 160 pts, CPB with isolated antegrade myocardial protection was used for redo CABG. Two different cardioplegic solutions were applied: HTK solution (n = 128; 65.6%) and blood cardioplegic solution (n = 32; 16.4%). Off pump redo CABG was performed in 35 pts (30 male (85.7%) and 5 female (14.3%) pts, age 67 ± 8 years). Demographic, pre–, intra– and postoperative data and a follow–up of all pts were recorded.

Perioperative overall mortality rate was 3.6% (n = 7) and comparable in both groups (on pump 3.8% vs off pump 2.9%), as well as perioperative myocardial infarction, IABP implantation rate and secondary morbidity. Complete revascularization was possible in 139 pts (86.7%) after on pump CABG and in 17 pts (48.6%) of the off pump group. The average number of grafts was significantly higher in the on pump group (2.8 ± 0.8 vs 1.6 ± 0.6, p <0.05). The perfusion time was 65 ± 39 min including a cross–clamp time of 38.9 ± 16 min. No conversion to ECC was necessary in the off pump group.

During the complete follow–up further 20 pts (12.5%) of the on pump group died, with 5 pts (25%) dying due to cardiac reasons. In the off pump group 3 pts (8.6%) died in the follow–up, both due to non–cardiac related reasons.

On pump redo CABG and off pump redo CABG can be safely performed with low mortality and morbidity. Off pump redo CABG might be limited due to incomplete revascularization.

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  1. Klinik für Herzchirurgie Herzzentrum Dresden Universitätsklinik, Fetscherstr. 76, 01307, Dresden, Germany

    Sems Malte Tugtekin, Manuel Wilbring, Heike Esche, Konstantin Alexiou, Utz Kappert, Michael Knaut & Klaus Matschke

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  1. Sems Malte Tugtekin
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  2. Manuel Wilbring
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  3. Heike Esche
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  4. Konstantin Alexiou
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  6. Michael Knaut
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  7. Klaus Matschke
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Tugtekin, S.M., Wilbring, M., Esche, H. et al. Koronarchirurgische Rezidivoperationen mit und ohne extrakorporaler Zirkulation. Z Herz- Thorax- Gefäßchir 19, 167–172 (2005). https://doi.org/10.1007/s00398-005-0498-9

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  • DOI: https://doi.org/10.1007/s00398-005-0498-9

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