KORONER ARTER BYPASS CERRAHİSİ SONRASI MAJOR ADVERS OLAYA ETKİ EDEN FAKTÖRLER

Year 2024, , 221 - 226, 29.04.2024

Hüsnü Kamil Limandal , Taha Özkara

https://doi.org/10.18229/kocatepetip.1315953

Abstract

AMAÇ: Çalışmamızda Koroner arter baypas greft (KABG) operasyonu geçiren hasta popülasyonumuzu mortalite ve major advers olay (MAO) gelişimi açısından incelemeyi ve MAO gelişimine etki eden faktörleri incelemeyi amaçladık.
GEREÇ VE YÖNTEM: Ocak 2017 ile Aralık 2019 tarihleri arasında KABG operasyonu olmuş 169 ardışık hasta retrospektif olarak incelenmiştir. Ölüm, miyokardiyal infarkt, reoperasyon, kardiyak tamponad, stroke, böbrek yetmezliği, sternal enfeksiyon extracorporeal membran oksijenatör ihtiyacı ve kardiyo pulmoner resüsitasyon MAO olarak tanımlandı.
BULGULAR: Hastaların yaş ortalaması 63,19 ±0,72 yıl, ortalama Kardiyopulmoner bypass (KPB) süresi 106,95 ±27 dakika, ortalama Aort Kros Klemp Süresi 44,87 ±1,05 dakika idi. 11 (%6,5) hastatya Ekstra Korporeal Membran Oksijenatör desteği sağlandı, 7 (%4,1) hastaya reoperasyon uygulandı, 5 (%3) hastada postoperatif stroke gözlendi, 5 (%3) hastaya kardiyopulmoner resusitasyon uygulandı ve 1 (%0,6) hasta postoperatif miyokardiyal enfarktüs gözlendi. Toplamda 28 (%16,6) hastada MAO gözlendi. Mortalite 9 (%5,3) hastada gözlendi. Univaryant analizde Euroskor, KPB sırasındaki ortalama arteryel basınç ve ultrafiltrasyon volümünün MAO ile ilişkili olduğu gözlendi (sırası ile p=0,004, p=0,026 ve p=0,037). Ancak multivaryant analizde sadece Euroskor (oddsratio: 1,453, %95 CI 1,166-1,811 p=0,001) ve ultrafiltrasyon volümü (oddsratio:-0,002, %95 CI 0,996-1 p=0,04) MAO ile ilişkili bulundu.
SONUÇ: Çalışmamızda yüksek Euroskor düzeylerinin sadece mortaliteyi değil aynı zamanda MAO insidansını da arttırdığı ve artmış ultrafiltrasyon volümlerinin MAO insidansını azalttığını gözlemledik. Uygun ultrafiltrasyon ve KPB stratejisinin MAO insidansını azaltabileceği KABG cerrahisi sırasında akılda bulundurulması gerektiği kanaatindeyiz.

Keywords

Majoradvers olay, Mortalite, Morbidite, Koroner arter bypass greftleme.

FACTORS AFFECTING MAJOR ADVERSE EFFECTS AFTER CORONARY ARTERY BYPASS SURGERY

Abstract

OBJECTIVE: The present study aimed to evaluate the patient population who underwent coronary artery bypass grafting (CABG) operation in terms of mortality and major adverse effects (MAE) incidence and examine the factors affecting MAE incidence.
MATERIAL AND METHODS: 169 consecutive patients who underwent CABG surgery between January 2017 and December 2019 were retrospectively analyzed. Mortality, myocardial infarction, reoperation, cardiac tamponade, stroke, renal failure, sternal infection, need for extracorporeal membrane oxygenator and cardio pulmonary resuscitation were defined as MAO.
RESULTS: The mean age of the patients was 63.19 ±0.72 years, the mean duration of cardiopulmonary bypass (CPB) was 106.95 ±27 minutes, and the mean duration of aortic cross-clamp was 44.87 ±1.05 minutes. Extracorporeal membrane oxygenator support was provided to 11 (6.5%) patients, 7 (4.1%) patients underwent reoperation, 5 (3%) patients experienced a postoperative stroke, 5 (3%) patients required cardiopulmonary resuscitation, and postoperative myocardial infarction was observed in 1 (0.6%) patient. In total, MAE was determined in 28 (16.6%) patients. Mortality occurred in 9 (5.3%) patients. In the univariate analysis, Euroscore, mean arterial pressure during CPB, and ultrafiltration volume were associated with MAE (p=0.004, p=0.026, and p=0.037, respectively). However, in multivariate analysis, only Euroscore (odds ratio: 1.453, 95% CI 1.166-1.811 p=0.001) and ultrafiltration volume (odds ratio:-0.002, 95% CI 0.996-1 p=0.04) were correlated to MAE.
CONCLUSIONS: In our study, we observed that high Euroscore levels increased not only mortality but also the incidence of MAO, and increased ultrafiltration volumes reduced the incidence of MAO. We believe that it should be kept in mind during CABG surgery that appropriate ultrafiltration and CPB strategy can reduce the incidence of MAO.

Keywords

Major adverse effects, Mortality, Morbidity, Coronary artery bypass grafting

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