Mitral Kapak Cerrahisinde İloprost Kullanımının Pulmoner Arter Hipertansiyonu Üzerine Klinik Etkisi

Year 2019, Volume: 22 Issue: 3, 182 - 187, 24.12.2019

Ümmühan Selçuk Gökçen Orhan Müge Taşdemir Bahar Temur Sevinç Bayer Murat Uğur Murat Sargın Serap Aykut

Abstract

Giriş: Mitral kapak cerrahisinde artmış pulmoner arter basıncı artmış mortalite ve morbidite için önemli bir risk faktörüdür. Biz bu çalışmada, prostaglandin analoğu iloprostun, pulmoner arteryel hipertansiyonu (PAH) olan hastalardaki hemodinamik etkilerini araştırdık.

Hastalar ve Yöntem: Çalışmamızda hastanemizde 01.01.2003-31.03.2013 tarihleri arasında mitral kapak cerrahisi uygulanan ve PAH nedeniyle intravenöz iloprost tedavisi uygulanan hastalar retrospektif olarak incelendi. Hastaların sistemik ve pulmoner arter basınçları kateter aracılığıyla elde edildi. Elde edilen preoperatif, postoperatif 0. ve 24. saatteki hemodinamik değerler incelendi.

Bulgular: Bu periyotta 135 hastaya mitral kapak replasmanı uygulanmış olup, 78 hastaya PAH nedeniyle iloprost tedavisi verilmişti. Hastaların %29.9’u erkek olup hastalar ortalama 54.45 ± 12.48 yaşında idi. Preoperatif değerler ile postoperatif 0 ve 24. saat sistemik ve pulmoner basınçlar karşılaştırıldığında; postoperatif 24. saatte pulmoner arter basıncının ve kan basıncının istatistiksel olarak anlamlı derecede azaldığı görüldü (p< 0.0001). Yaş, preoperatif ejeksiyon fraksiyonu ve revizyon mortalite açısından anlamlı risk faktörü olarak belirlendi (p< 0.0001). Pulmoner basınçlar mortalite açısından risk faktörü olarak bulunmadı.

Sonuç: Yüksek pulmoner arter basınçlı hastalarda iloprost tedavisi postoperatif erken dönemde pulmoner arter basıncını düşürerek hastanın iyileşmesine katkı sağlar. Mitral kapak replasmanı esnasında iloprost tedavisi pulmoner arter basıncını düşürerek, peroperatif mortalite riskini azaltır.

Keywords

Mitral kapak cerrahisi, kardiyopulmoner baypas, iloprost, pulmoner hipertansiyon

Clinical Effect of Iloprost on Pulmonary Artery Hypertension After Mitral Valve Surgery

Abstract

Introduction: Pulmonary arterial hypertension (PAH) is an important risk factor for increased mortality and morbidity during mitral valve surgery. In this study, we analysed the haemodynamic effects of the prostaglandin analogue iloprost in patients with PAH.

Patients and Methods: We retrospectively analysed patients with PAH who were undergoing mitral valve surgery and had received intravenous iloprost therapy at our hospital from 1 January 2003 to 31 March 2013. Systemic and pulmonary arterial pressures were measured with catheterisation. The haemodynamic parameters were administered preoperatively and at 0 hours and 24 hours postoperatively.

Results: A total of 135 patients had undergone mitral valve operations, of whom 78 patients were administered iloprost during the study period. Of all the cases, 29.9% were male and the average patient age was 54.45 ± 12.48 years. A comparison of the preoperative, hour 0 and hour 24 baseline parameters showed that pulmonary artery pressure and blood pressure statistically significantly decreased at postoperative hour 24 (p< 0.05). Age, preoperative EF and revisions were found to be statistically significant risk factors for mortality (p< 0.0001). Pulmonary pressures did not affect mortality and were not classified as risk factors.

Conclusion: Iloprost treatment might improve postoperative outcomes in patients with high pulmonary arterial pressures and with decreasing pulmonary arterial pressures in the early postoperative period. Treatment with iloprost during the mitral valve replacement decreases high pulmonary arterial pressures and the peroperative mortality risk.

Keywords

Mitral valve surgery, cardiopulmonary bypass, iloprost, pulmonary hypertension

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