Sistemik Otoimmün Hastalık Tanılı Hastalarda Koroner Arter Bypass Greftleme Cerrahisi

Year 2023, Volume: 6 Issue: 1, 169 - 177, 30.04.2023

İbrahim Çağrı Kaya , Halil İbrahim Bulut , Merih Özbayburt , Ozan Onur Balkanay

https://doi.org/10.36516/jocass.1270607

Abstract

Giriş: Sistemik otoimmün hastalıklar, kardiyovasküler hastalıklar için risk faktörleridir ve ayrıca çeşitli cerrahi uzmanlıklarda perioperatif sonuçları kötüleştiren bir faktör olarak tanımlanmıştır. Bu çalışmanın amacı, sistemik otoimmün hastalıkların koroner cerrahi sonuçları üzerindeki etkilerini araştırmaktır.
Gereç ve Yöntemler: Çalışmaya tarafımızca koroner arter bypass cerrahisi yapılan yüz elli bir hasta dahil edildi. Otoimmün hastalığı olmayan 144 hasta ikinci grupta, sistemik otoimmün hastalığı olup izole koroner cerrahi uygulanan yedi hasta ikinci grupta yer aldı. Verilerin toplanmasında Hastane Elektronik kayıt sistemleri kullanılmıştır. Takip süresi 12 aydır. İstatistiksel olarak anlamlı P değeri 0,05 olarak kabul edilmiştir.
Sonuç : İki grup preoperatif olarak karşılaştırıldığında; sadece ikinci grupta hipertansiyon ve diyabet prevalansı anlamlı olarak daha yüksekti. İntraoperatif değişkenler açısından iki grup arasında anlamlı fark yoktu. Perioperatif komplikasyonlar (inme hariç), 30 günlük mortalite ve postoperatif kardiyopulmoner resüsitasyon oranı ikinci grupta anlamlı olarak yüksekti, ancak 12 aylık sağkalım açısından iki grup arasında fark yoktu.
Tartışma : Sistemik otoimmün hastalıklar koroner cerrahi açısından komplikasyonları artıran bir faktör olarak bulunmasına rağmen, koroner cerrahi bu hastalarda 12 aylık sağkalım başarısı ve tekrarlayan revaskülarizasyon oranı ile umut vericidir.

Keywords

Otoimmün Hastalıklar, Miyokardiyal revaskülarizasyon, Koroner arter bypass cerrahisi, iskemik kalp hastalıkları

Coronary Artery Bypass Grafting Surgery for Patients with Systemic Autoimmune Diseases: Institutional Experience

Abstract

Introduction:
Systemic autoimmune diseases are risk factors for cardiovascular diseases and have also been identified as a factor that worsens perioperative outcomes in various surgical specialities. This study investigated the effects of systemic autoimmune diseases on coronary surgery outcomes.

Methods:

One hundred fifty-one patients were included in this study. hundred-forty-four patients without autoimmune disease were in the second group and seven patients with systemic autoimmune disease who underwent isolated coronary surgery were in the second group. Hospital Electronic recording systems were used for data collection. The follow-up period is 12 months. A statistically significant P value was taken as 0.05.

Results:

The two groups were comparable preoperatively, only the prevalence of hypertension and diabetes was significantly higher in the second group. There was no significant difference between the two groups in terms of intraoperative variables. Perioperative complications (excluding stroke), 30-day mortality and post-operative cardiopulmonary resuscitation rate were significantly higher in the second group, however there was no difference between the two groups in terms of 12-month survival.

Conclusion:
Despite systemic autoimmune diseases being found a factor that increases complications in terms of coronary surgery, coronary surgery is promising with its success in 12-month survival and repeated revascularization rate in these patients.

Keywords

Autoimmune Disease, Myocardial Revascularization, Coronary Artery Bypass Grafting, Ischemic Heart Disease

References

• 1. Sherer Y, Shoenfeld Y. Mechanisms of disease: atherosclerosis in autoimmune diseases. Nature clinical practice Rheumatology. 2006;2(2):99-106. https://doi.org/10.1038/ncprheum0092
• 2. Bulkeley BH, Roberts WC. The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy. The Am J Med. 1975; 58: 243-64. https://doi.org/10.1016/0002-9343(75)90575-6
• 3. Perk J, De Backer G, Gohlke H et al. European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2012;33:1635-701. https://doi.org/10.1093/eurheartj/ehs092
• 4. Lindhardsen J, Ahlehoff O, Gislason G, et al. The risk of myocardial infarction in rheumatoid arthri¬tis and diabetes mellitus: a Danish nationwide co¬hort study. Annals of the rheumatic diseases. 2011;70(6):929-34. https://doi.org/10.1136/ard.2010.143396
• 5. Frostegard J. Atherosclerosis in patients with au-toimmune disorders. Arteriosclerosis, thrombosis, and vascular biology. 2005;25(9):1776-85. https://doi.org/10.1161/01.ATV.0000174800.78362.ec
• 6. Ma G, Zhao H, Fei Y, et al. Autoimmune diseases may increase adverse cardiovascular events after percutaneous coronary intervention: a systematic review and meta-analysis. Heart, Lung and Circu¬lation. 2019;28(10):1510-24. https://doi.org/10.1016/j.hlc.2018.07.012
• 7. Pepe M, Napoli G, Carulli E, et al. Diseases in pa-tients undergoing percutaneous coronary inter-vention: A risk factor for in-stent restenosis? Ath-erosclerosis. 2021;333:24-31. https://doi.org/10.1016/j.atherosclero-sis.2021.08.007
• 8. Aguayo E, Dobaria V, Sareh S, et al. National Analysis of Coronary Artery Bypass Grafting in Autoimmune Connective Tissue Disease. Ann Thorac Surg. 2020;110(6):2006-12. https://doi.org/10.1016/j.athoracsur.2020.03.120
• 9. Sponga S, Ferrara V, Dagenais F, et al. Autoim-mune Connective Tissue Diseases and Cardiac Surgery. Circulation. 2021; 144(Suppl_1):A13880-A13880. https://doi.org/10.1161/circ.144.suppl_1.13880
• 10. Baena-Díez JM, Garcia-Gil M, Comas-Cufi M, et al. Association between chronic immune-medi-ated inflammatory diseases and cardiovascular risk. Heart. 2018;104.2:119-26. https://doi.org/10.1136/heartjnl-2017-311279
• 11. Shoenfeld Y, Gerli R, Doria A, et al. Accelerated atherosclerosis in autoimmune rheumatic dis-eases. Circulation. 2005;112(21),3337-47. https://doi.org/10.1161/Circula-tionaha.104.507996
• 12. Elezaby A, Dexheimer R, Sallam K. Cardiovascu¬lar effects of immunosuppression agents. Fron¬tiers in Cardiovascular Medicine. 2022;9: 981838 https://doi.org/10.3389/fcvm.2022.981838
• 13. Lai CH, Lai WW, Chiou MJ, et al. Outcomes of coronary artery bypass grafting in patients with inflammatory rheumatic diseases: an 11-year na¬tionwide cohort study. The Journal of Thoracic and Cardiovascular Surgery. 2015;149(3):859-66. https://doi.org/10.1016/j.jtcvs.2014.11.038
• 14. Wassif H, Saad M, Desai R, et al. Outcomes Fol-lowing Acute Coronary Syndrome in Patients with and without Rheumatic Immune‐Mediated Inflammatory Diseases. Journal of the American Heart Association. 2022;11(18):e026411. https://doi.org/10.1161/JAHA.122.026411
• 15. Varghese JJ, Koneru S, Scaife SL, et al. Mortality after coronary artery revascularization of patients with rheumatoid arthritis. The Journal of thoracic and cardiovascular surgery. 2010;140(1):91-6. https://doi.org/10.1016/j.jtcvs.2009.09.036
• 16. Birdas TJ, Landis JT, Haybron D, et al. Outcomes of coronary artery bypass grafting in patients with connective tissue diseases. The Annals of thoracic surgery. 2005;79(5):1610-4. https://doi.org/10.1016/j.athoracsur.2004.10.052
• 17. Chai T, Zhuang X, Tian M, et al. Meta-Analysis: Shouldn't Prophylactic Corticosteroids be Admin¬istered During Cardiac Surgery with Cardiopul¬monary Bypass? Frontiers in Surgery. 2022;9:832205. https://doi.org/10.3389/fsurg.2022.832205
• 18. Kaya İ. New Heart Centre: Eskisehir City Hospi-tal-First Results. Koşuyolu Heart Journal. 2019; 22(3): 193-7. https://doi.org/10.5578/khj.68859