Açık kalp cerrahisinde geçici epikardiyal pacemaker tellerinin kullanılmasının klinik önemi

Year 2015, Volume: 25 Issue: 3, 77 - 80, 01.09.2015

Elif Coşkun Mustafa Büyükateş Fatih Tomrukçu

Abstract

Amaç: Açık kalp cerrahisi sırasında ve sonrasında geçici epikardiyal pacemaker desteği gerekebilmektedir. Bu çalışmanın amacı; erişkin açık kalp cerrahisinde pacemaker gereksinimi oluşturabilecek faktörlerin tespiti ve kullanım endikasyonlarının sınırlandırılmasıdır. Gereç ve yöntem: Çalışmaya Mayıs 2002-Kasım 2013 tarihleri arasında kliniğimizde açık kalp cerrahisi yapılan ve geçici epikardiyal pacemaker teli yerleştirilen 736 hasta dahil edilmiştir. Hastalarımızın yaş, cinsiyet ve geçirilen operasyon şekline göre sınıflandırıldı. Uygulanan cerrahi operasyonlar izole koroner revaskülarizasyon yapılan 665 hasta, aort kapak replasmanı yapılan 23 hasta, mitral kapak replasmanı 21 hasta, aort ve mitral kapak replasmanı beraber yapılan 7 hasta, çıkan aort replasmanı 6 hasta, atriyal septal defekt tamiri 9 hasta ve kardiyak kitle 5 hasta şeklinde idi. Bulgular: Epikardiyal pacemaker teli yerleştirilen hastaların 714 %97 ’ünde pacemaker desteğine ihtiyaç olmamıştır. İntraoperatif ve postoperatif dönemde yalnızca 22 %3 ’ünde atrioventriküler tam blok nedeni ile pacemaker kullanılması gerekti. Bu hastaların 6 tanesi sağ koroner arter lezyonu olan çoklu koroner arter sebebi ile by-pass cerrahisi uygulanan hastalardı. 16 tanesi valvüler cerrahi geçiren ve pompa çıkışı atriyoventriküler tam blok oluşan hastalar idi. Geçici epikardiyal pacemaker kullanılıp aort kapak replasmanı yapılan yalnızca 2 hastada persistan komplet dal bloğu sebebi ile kalıcı pacemaker uygulandı. Erken postop dönemde geçici epikardiyal pacemaker gereksinimi için atriyoventriküler blok, sinüs bradikardisi, junctional ritim, postperfüzyon atriyal fibrilasyon, kardiyopulmoner by-passdan ayrılma esnasında pacemaker ihtiyacı ve mitral müdahale gerektiren cerrahiler risk faktörleri olarak bulunmuştur. Epikardiyal pacemaker tellerinin kullanımı ve çekilmesi sırasında hiçbir komplikasyon oluşmamıştır. Sonuç: Kalp cerrahisinde epikardiyal pacemaker tellerinin rutin kullanılması gerekli değildir ancak açık kalp cerrahisi geçiren tüm hastalarda hayat kurtarıcı olması nedeni ile geçici epikardiyal pace tellerinin yerleştirilmesini öneriyoruz

Keywords

Açık kalp cerrahisi, kalp pili, atriyoventriküler blok, aritmiler

Clinical significance of temporary epicardial pacemaker wires using in open heart surgery

Abstract

Objectives: Temporary epicardial pacemaker support may be required during and/or after open heart surgery. The aim of the current study was to define the factors that may require pacemaker insertion in adult open heart surgery and to limit its’ indications. Mate- rial and methods: We had included 736 patients that underwent open heart surgery and received temporary epicardial pacemaker in our clinic between May 2002 and November 2013. All patients were categorized according to age, gender and type of surgery. Types of surgery were as follows: Isolated coronary revascularization 665 patients , aortic valve replacement 23 patients , mitral valve re- placement 21 patients , aortic and mitral valve replacement 7 patients , ascending aorta replacement 6 patients , atrial septal defect repair 9 patients and cardiac tumor resection 5 patients . Results: Pacemaker support was not required in 714 97% patients that receive temporary epicardial pacing wires. Pacemaker was used in only 22 patients 3% during and after surgery due to the complete atrioventricular AV block. Six of these patients underwent coronary artery bypass surgery due to multi-vessel disease. Sixteen of these patients underwent valvular surgery and experienced AV complete block. Permanent pacemaker was used in only 2 patients due to persistant complete bundle branch block after aortic valve replacement. AV block, sinus bradycardia, junctional rhythm, post-perfusion atrial fibrillation, during separation from caridopulmonary bypass need for pacemaker and mitral intervention requir- ing surgery were found as risk factors for temporary epicardial pacemaker requirement in early post-op period. No complication was encountered during usage and removal of epicardial pacing wires. Conclusion: Routine usage of epicardial pacing wires in cardiac surgery were not required. However, we recommend insertion of temporary epicardial pacing wires in all patients who underwent open heart surgery due to its’ life saving potential

Keywords

Open heart surgery, pacemaker, atrioventricular block, arrhytmias

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