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Læknablaðið - 15.09.2012, Blaðsíða 16

Læknablaðið - 15.09.2012, Blaðsíða 16
RANNSÓKN Þakkir Þakkir fær Gunnhildur Jóhannsdóttir fyrir aðstoð við leit að sjúkraskrám, Sigurlaug Magnúsdóttir fyrir upplýsingar um fjölda kransæðavíkkana og Sigurjón H. Ólafsson fyrir yfirlestur. Rannsóknin var styrkt af Vísindasjóði Landspítala, Minningarsjóði Bengt Scheving Thorsteinssonar, Rannsóknarsjóði Háskóla íslands og Minningarsjóði Helgu Guðmundsdóttur og Sigurliða Kristjánssonar. Heimildir 1. Arnórsson Th, Ólafsson G, Alfreðsson H, Johannsson KB, Gudbjartsson T. Ágrip erinda af vísindaþingi Skurðlæknafélags íslands og Svæfinga- og gjörgæslulæknafélags íslands. E 24. Vísindaþing SKÍ og SLFÍ: Læknablaðið 2007: 93; 320. 2. Banning AP, Westaby S, Morice MC, Kappetein AP, Mohr FW, Berti S, et al. Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. J Am CoII Cardiol 2010;55:1067-75. 3. Durham S Ji GJLCoCS. Cohn L: Cardiac Surgery in the Adult. New York: McGraw-Hill; 2008. 4. Magee MJ, Alexander JH, Hafley G, Ferguson TB Jr, Gibson CM, Harrington RA, et al. Coronary artery bypass graft failure after on-pump and off-pump coronary artery bypass: findings from PREVENT IV. Ann Thor Surg 2008; 85: 494-500. 5. Chu D, Bakaeen FG, Dao TK, LeMaire SA, Coselli JS, Huh J. On-Pump Versus Off-Pump Coronary Artery Bypass Grafting in a Cohort of 63,000 Patients. Ann Thor Surg 2009; 87:1820-7. 6. Shroyer AL, Grover FL, Hattler B, et al. On-Pump versus Off-Pump Coronary-Artery Bypass Surgery. N Engl J Med 2009; 361:1827-37. 7. Gold JP, Wasnick J, Maldarelli W, Zhuraavlev I, Torres KE, Condit D. Selective use of off-pump coronary bypass surgery reduces mortality and neurologic morbidity associated with high-risk coronary bypass surgery: A 400- case comparative experience. Heart Surgery Forum 2004; 7:E562-E8. 8. Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG,et al. Off-pump vs conventional coronary artery bypass grafting: Early and 1-year graft patency, cost, and quality-of-life outcomes a randomized trial. JAMA2004; 291:1841-9. 9. Kobayashi J, Tashiro T, Ochi M, Yaku H, Watanabe G, Satoh T, et al. Early outcome of a randomized comparison of off-pump and on-pump multiple arterial coronary revascularization. Circulation 2005; 112:1338-143. 10. Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, Collins P, et al. A randomized comparison of off- pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med 2004; 350: 21-8. 11. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, Straka Z, et al. Off-Pump or On-Pump Coronary-Artery Bypass Grafting at 30 Days. N Engl J Med 2012; 366:1489-97. 12. Oddsson SJ, Sigurjonsson H, Helgadottir S, Sigurdsson MI, Viktorsson SA, Arnorsson Th, et al. Tengsl offitu við árangur kransæðahjáveituaðgerða. Læknablaðið 2011; 97: 223-8. 13. Sigurdsson MI, Helgadottir S, Ingvarsdottir IL, Viktorsson SA, Hreinsson K, Amorsson Th, et al. Árangur krans- æðahjáveituaðgerða og ósæðarlokuskipta hjá öldruðum. Læknablaðið 2012; 98:15-8. 14. Cleveland JC, Shroyer ALW, Chen AY, Peterson E, Grover FL. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thor Surg 2001; 72:1 282-8. 15. Ivert T. Svensk hjártkirurgiregistret. In. Stockholm: Svensk Thoraxkirurgisk Förening; 2006. 16. Shroyer AL, Coombs LP, Peterson ED, Eiken MC, DeLong ER, Chen A, et al. The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models. Ann Thorac Surg 2003; 75:1856-64; discussion 64-5. 17. Zaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, MiIIs PG. Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification. Circulation 2000; 101:1403-8. 18. Koletsis EN, Prokakis C, Crockett JR, Dedeilias P, Panagiotou M, Panagopoulos N, et al. Prognostic factors of atrial fibrillation following elective coronary artery bypass grafting: the impact of quantified intraoperative myocardial ischemia. J Cardiothorac Surg 2011; 6:127. 19. Merie C, Kober L, Olsen PS, Andersson C, Jensen JS, Torp- Pedersen C. Risk of stroke after coronary artery bypass grafting: effect of age and comorbidities. Stroke 2012; 43: 38-43. 20. Steingrimsson S, Gottfredsson M, Kristinsson KG, Gudbjartsson T. Deep sternal wound infections following open heart surgery in Iceland. A population-based study. Scand Cardiovasc J 2008; 42: Í208-13. 21. Ingvarsdottir IL, Viktorsson SA, Hreinsson K, Sigurðsson MI, Helgadóttir S, Amorsson Th, et al. Lokuskipti vegna ósæðarlokuþrengsla á íslandi 2002-2006: ábendingar og snemmkomnir fylgikvillar. Læknablaðið 2011; 97: 523-7. 22. Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg 2004; 78: 527-34; discussion 34. 23. Uffman JK, Berry BE. On-pump versus off-pump coronary artery bypass surgery: a comparison of two consecutive series. J La State Mcd Soc 2008; 160: 204-7. 24. Surgeons TSoT. STS National Database. In; 2009. 25. Edgerton JR, Dewey TM, Magee MJ, Herbert MA, Prince SL, Jones KK, et al. Conversion in off-pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg 2003; 76:1138-42; discussion 42-3. ENGUSH SUMMARY Outcome of myocardial revascularisation in lceland Sigurjonsson H12, Helgadottir S', Oddsson S1, Sigurdsson M1-2, Geirsson A1, Arnorsson Th1, Gudbjartsson T12 Introduction: In lceland over 3500 coronary artery bypass operations have been performed, both On-Pump, using cardiopulmonary bypass and Off-Pump, surgery on a beating heart. The aim was to study their outcome. Material and methods: This was a retrospective study on 720 consecutive patients who underwent surgical revascularisation at Landspítali -The National University Hospital of lceland between 2002- 2006; 513 On-Pump and 207 Off-Pump patients. Complications and operative mortality (<30 days) were compared between the groups and predictors of survival identified using multivariate analysis. Results: The number of males was significantly higher in the On-Pump group, but other risk factors of coronary artery disease, including age and high body mass index, were comparable, as were the number of distal anastomoses and EuroSCORE. The Off-Pump procedure took 25 minutes longer on average and chest tube output was significantly increased, but the amount of transfusions administered was similar. The rate of minor complications was higher in the On-Pump group. Of the major complications, stroke rates were similar in both groups (2%) but the rate of reoperation for bleeding was higher in the On-Pump group. Mean length of hospital stay was one day longer for On-Pump patients but operative mortality was similar for both groups (4% vs. 3%, p=0.68) as was 5 year survival (92% in both groups). In multivariate analysis both EuroSCORE and age predicted outcome of operative mortality and long term survival but type of surgery (On-Pump vs. Off- Pump) was not a predictive variant. Conclusions: Outcome of myocardial revascularisation in lceland is good as regards operative mortality and long term survival. This applies to both conventional On-Pump and Off-Pump procedures. Key words: Coronary artery bypass graft (CABG), off-pump coronary artery bypass surgery (OPCAB), complications, operative mortatity, survival, population based. Correspondence: Tómas Guðbjartsson, tomasgud@iandspitaii.is 'Department of Cardiothoracic Surgery, Landspitali - The National University Hospital of lceland, *Facuity of Medicine, University of lceland, Reyk/avik, lceland 456 LÆKNAblaðið 2012/98
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