Abstract
Aim: After open heart surgery in patients with hemodynamic instability due to bleeding and / or pericardial tamponade interventions must be done without losing time. Although urgent revision rate vary according to clinical to clinical. More than 80 % of cases is due to the bleeding. Here we want to offer patients where we take urgent revision. Materials and Methods: Between January 2013 and June 2014, 123 open heart surgery is performed by two surgeons. 9 patients (7.3 %) (one female, eight male ) were taken Urgent revision due to bleeding and / or pericardial tamponade. The mean age of the patients was 57,7 . Female patient underwent mitral valve replacement (MVR) + coronary artery bypass graft (CABG), other patients underwent CABG surgery. Results: MVR + CABG patient in the post-op day 4 , other patients post-op within the first 8 hours were operated for revision. Saphenous vein distal anastomoses were bleeding in two patients. One patient had bleeding as a common oozing. İn other patients could not be detected focus will explain the bleeding. There was no bleeding in patients undergoing MVR + CABG surgery, but she had serous fluid. Nosocomial infection occurred in two patients. There was no mortality among patients undergoing revision. Conclusion: If hemodynamic deterioration occurs in patients after open heart surgery, making rapid assessment and taking urgent revision, we believe will reduce mortality and morbidity
References
- REFERANSLAR:
- -Aksoy R, Kalaycıoğlu L, Arslan DG, Balcı AY, Özdemir F, Tuygun AK, Yekeler İ. Ameliyat sonrası erken dönemde hemodinamik instabilitenin tedavi yaklaşımı. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2014;22(2):291-7.
- - Unsworth-White MJ, Herriot A, Valencia O, et al. Resternotomy for bleeding after cardiac operation: a marker for increased morbidity and mortality. Ann Thorac Surg 1995;59:664-7.
- - Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993;56:539-49.
- - Ottino G, De Paulis R, Pansini S, et al. Major sternal wound infection after open heart surgery: a multivariate analysis of risk factors in 2579 consecutive operative procedures. Ann Thorac Surg 1987;44:173-9.
- -Fiser SM, Tribble CG, Kern JA,et al. Caediac reoperation in the intensive care unit. Ann Thorac Surg
- - Borger MA, Rao V, Weisel RD,et al. Deep seternal wound infection: risk factors and outcomes.Ann Thorac Surg 1998;65:1050-6
- - Kirklin JW, Barratt-Boyes BG. Cardiac Surgery. 2nd ed.New York: John Wiley; 1993;p. 222.
- - Ozatik MA,Göl K, Budak B, Küçüker Ş, Sarıtaş A, Mavitaş B, et al. Reexploration for bleeding and tamponade in the intensive care unit following open heart surgery. [Article in Turkish] Anadolu Kardiyol Derg 2004;4:19-22
- -Sellman M, Intonti MA, Ivert T. Reoperation for bleeding after coronary artery bypass procedures during 25 years. Eur. J Cardio/thorac Surg. 1977;11:521-7.
- - Moultan MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg 1996;111:1037-46.
- - Dacey LJ, Munoz JJ, Baribeau YR, et al. Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England Cardiovascular Disease Study Group. Arch Surg 1998;133:442-7.
- - Kaiser GC, Naunheim KS, Fiore AC, et al. Reoperation in the intensive care unit. Ann Thorac Surg 1990;49:903-8.
- - Gerçekoğlu H, Keser S, Flimflek S, et al. Açık kalp cerrahisi sonrası kanama nedeniyle yapılan reeksplorasyonun risk faktörü olarak değerlendirilmesi.Türk Göğüs Kalp Damar Cer Derg 1997;7:435-7.
Açık Kalp Cerrahisi Sonrası Kanama Ve/Veya Tamponad Nedeniyle Erken Dönemde Acil Yapılan Revizyonlar.
Abstract
ÖZET
AMAÇ: Açık kalp cerrahisi(AKC) sonrası kanama ve/veya tamponad nedeniyle hemodinamik instabilite gelişen hastalara gerekli müdahale zaman kaybetmeden yapılmalıdır. Acil revizyon oranı klinikten kliniğe göre değişkenlik göstermekle birlikte olguların %80’den fazlası kanamaya bağlıdır. Biz burada acil revizyona aldığımız hastaları sunmak istedik.
YÖNTEM: Ocak 2013-Haziran 2014 tarihleri arasında iki cerrah tarafından 123 AKC ameliyatı yapılmış olup, 9 hasta(%7,3) (bir kadın,sekiz erkek) kanama ve/veya tamponad nedeniyle acil revizyona alınmıştır. Hastaların yaş ortalaması 57,7(53-71).Kadın hastaya Mitral Valv replasmanı(MVR)+koroner arter baypass greft(KABG) diğer hastalara KABG ameliyatı yapıldı.
BULGULAR: MVR+KABG hastası post-op 4.günde diğer hastalar post-op ilk 8 saat içerisinde revizyona alınmıştır. Hastaların ikisinde safen distal anastamozunda kanama vardı. Bir hasta’da yaygın sızıntı şeklinde kanama vardı, diğer hastalarda kanamayı izah edecek bir odak tespit edilememiştir. Kapak+koroner ameliyatı yapılan hastada ise seröz mayi vardı kanama yoktu. Hastalardan ikisinde hastane enfeksiyonu gelişti . Revizyona alınan hastaların hiçbirinde mortalite görülmedi.
SONUÇ: AKC sonrasında hastalarda hemodinamik bozulma varsa, hızlı değerlendirme yapılarak erken dönemde acil revizyona alınması hastalarda gelişebilecek mortalite ve morbiditeği azaltacağına inanyoruz.
ANAHRTAR SÖZCÜKLER: Kardiyak cerrahi işlemler; Ameliyat sonrası komplikasyon ; re-eksplorasyon
References
- REFERANSLAR:
- -Aksoy R, Kalaycıoğlu L, Arslan DG, Balcı AY, Özdemir F, Tuygun AK, Yekeler İ. Ameliyat sonrası erken dönemde hemodinamik instabilitenin tedavi yaklaşımı. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2014;22(2):291-7.
- - Unsworth-White MJ, Herriot A, Valencia O, et al. Resternotomy for bleeding after cardiac operation: a marker for increased morbidity and mortality. Ann Thorac Surg 1995;59:664-7.
- - Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993;56:539-49.
- - Ottino G, De Paulis R, Pansini S, et al. Major sternal wound infection after open heart surgery: a multivariate analysis of risk factors in 2579 consecutive operative procedures. Ann Thorac Surg 1987;44:173-9.
- -Fiser SM, Tribble CG, Kern JA,et al. Caediac reoperation in the intensive care unit. Ann Thorac Surg
- - Borger MA, Rao V, Weisel RD,et al. Deep seternal wound infection: risk factors and outcomes.Ann Thorac Surg 1998;65:1050-6
- - Kirklin JW, Barratt-Boyes BG. Cardiac Surgery. 2nd ed.New York: John Wiley; 1993;p. 222.
- - Ozatik MA,Göl K, Budak B, Küçüker Ş, Sarıtaş A, Mavitaş B, et al. Reexploration for bleeding and tamponade in the intensive care unit following open heart surgery. [Article in Turkish] Anadolu Kardiyol Derg 2004;4:19-22
- -Sellman M, Intonti MA, Ivert T. Reoperation for bleeding after coronary artery bypass procedures during 25 years. Eur. J Cardio/thorac Surg. 1977;11:521-7.
- - Moultan MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg 1996;111:1037-46.
- - Dacey LJ, Munoz JJ, Baribeau YR, et al. Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England Cardiovascular Disease Study Group. Arch Surg 1998;133:442-7.
- - Kaiser GC, Naunheim KS, Fiore AC, et al. Reoperation in the intensive care unit. Ann Thorac Surg 1990;49:903-8.
- - Gerçekoğlu H, Keser S, Flimflek S, et al. Açık kalp cerrahisi sonrası kanama nedeniyle yapılan reeksplorasyonun risk faktörü olarak değerlendirilmesi.Türk Göğüs Kalp Damar Cer Derg 1997;7:435-7.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Original Articles |
| Authors | |
| Publication Date | April 8, 2015 |
| Submission Date | February 20, 2015 |
| Published in Issue | Year 2015 Volume: 6 Issue: 21 |
