Kardiyak Travmada Cerrahi Tedavi Deneyimi: Tek Merkezli Çalışma

Year 2022, , 295 - 302, 31.08.2022

Semih Murat Yücel , Fatih Çalışkan

https://doi.org/10.24938/kutfd.1097513

Abstract

Amaç: Kardiyak travma yüksek mortalite oranına sahiptir ve acil tanı ve cerrahi tedavi gerektirir. Bu retrospektif çalışma, kardiyak travma nedeniyle acil cerrahi tedavi uygulanan hastaların sonuçlarını kardiyak yaralanma skor sistemleri kullanılarak değerlendirmek amacıyla planlandı.

Gereç ve Yöntemler: Ocak 1985-Kasım 2021 tarihleri arasında acil servisimize başvuran ve kardiyak travma nedeniyle cerrahi operasyon geçiren tüm travmalı hastalar retrospektif olarak incelendi. Perkütan girişim sonrası iyatrojenik kalp travması gelişen hastalar da çalışma popülasyonuna dahil edildi. Tüm hastalarda fizyolojik indeks (PI), penetran kardiyak travma indeksi (PCTI), penetran torasik travma indeksi (PTTI) ve American Association for the Surgery of Trauma Organ Injury Ölçeği (AAST/OIS) gibi kardiyak yaralanma ölçekleri ile klinik şiddet hesaplandı.

Bulgular: Çalışmada 39 hasta yer aldı. Hastaların 24’ünde (%61.6) penetran, 13’ünde (%33.3) iyatrojenik, 2’sinde (%5.1) künt kalp yaralanması vardı. Hastaların 15’inde (%38.5) delici bıçak yarası, 9’unda (%23.1) ateşli silah yaralanması vardı. Hastaların yaş ortalaması 48.3±19.0 (min: 6-maks: 87) /yıl ve %79.6’sı erkekti. En sık yaralanan kalp boşlukları sırasıyla sağ ventrikül (RV) (%46.2), sol ventrikül (LV) (%25.6), sağ atriyum (RA) (%10.3) ve koroner arterler (%10.3) idi. Kardiyak tamponadlı hasta sayısı 25 (%64.1) iken, 6 (%15.4) hastada ek karın yaralanması tespit edildi. Kardiyak tamponadlı hastaların %80’i hayatta kaldı (p=0.006). Bu çalışmada mortalite oranı, penetran yaralanmalar için %35 olarak bulunmuştur.

Sonuç: Çalışmamızın verileri, mortalite üzerine kardiyak tamponadın negatif etkisi olduğunu göstermekle birlikte sağ ve sol ventrikül yaralanmasının mortalite açısından karşılaştırmasında istatistiksel bir fark göstermemiştir. Çalışma sonuçlarımız, sol ventrikül yaralanmalarının daha yüksek mortalite gösterdiği şeklindeki eski görüşü de desteklememektedir.

Keywords

kardiyak yaralanma şiddet indeksi, Kalp yaralanmaları, cerrahi, penetran, künt

EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY

Abstract

Objective: Cardiac trauma has a high mortality rate and requires emergency diagnosis and surgical treatment. This retrospective study was planned to evaluate outcomes of patients who underwent urgent surgical treatment for cardiac trauma using valuable injury scoring systems.

Material and Methods: All traumatic patients who applied to our emergency service and performed surgical operations due to cardiac trauma between January 1985 and November 2021 by cardiovascular surgeons, were analyzed retrospectively. The patients with iatrogenic cardiac trauma after the percutaneous intervention were also included in the study population. Cardiac injury scales such as physiological index (PI), penetrating cardiac trauma index (PCTI), penetrating thoracic trauma index (PTTI), and American Association for the Surgery of Trauma/Organ Injury Scale (AAST/OIS), were calculated in all patients for clinical severity.

Results: In this study, 39 patients were enrolled. 24 patients (61.6%) had penetrating, 13 (33.3%) iatrogenic, 2 (5.1%) blunt cardiac injuries. 15 patients (38.5%) had penetrating stab wounds, and 9 (23.1%) had gunshot wounds. The mean age of the patients was 48.3±19.0 (min: 6-max: 87) years, and 79.6% were male. The most frequently injured cardiac chambers were right ventricle (RV) (46.2%), left ventricle (LV) (25.6%), right atrium (RA) (10.3%), and coronary arteries (10.3%), respectively. While the number of patients with cardiac tamponade was 25 (64.1%), additional abdominal injuries were detected in 6 (15.4%) patients. 80% of the patients with cardiac tamponade survived (p=0.006). The mortality rate was 35% for penetrating injuries in this study.

Conclusion: This study, which included patients with cardiac trauma from a single-center, draws attention in terms of showing the negative effect of cardiac tamponade on mortality. Our study outcomes also do not support the old dictum that left ventricular injuries have higher mortality.

Keywords

Heart injuries, surgery, cardiac injury severity index, penetrating, blunt

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