YENİ KURULAN MERKEZİMİZİN 4 YILLIK AÇIK KALP AMELİYAT SONUÇLARININ DEĞERLENDİRİLMESİ

Yıl 2018, Cilt: 51 Sayı: 3, 219 - 222, 26.12.2018

Hasan Attila Keskin

Öz

AMAÇ: Ebulfez Elçibey Kalp ve Damar Cerrahisi Merkezi 2012 yılında kurulmuş ve ilk açık kalp ameliyatı 17.7.2012 tarihinde başarı ile gerçekleştirilmiştir. Bu makalede,  4 yılda ameliyat edilen hastaların sonuçlarını retrospektif olarak değerlendirerek literatür ile karşılaştırmayı planladık.

GEREÇ VE YÖNTEM: 17 Temmuz 2012 ve 15.07.2016 tarihleri arasında 1079 hastaya 1092  kalp ameliyatı yapılmıştır. Hastaların verileri, pompa formları, ekokardiyografi bulguları ve hastanenin bilgi kayıt sisteminden toplanmıştır. Hastaların %96’ı konvansiyonel olarak kardiyopulmoner baypas tekniğiyle, %3’ü çalışan kalpte  kardiyopulmoner baypas ile kapak ameliyatları  ve %1’i de  off-pump çarpan kalpte  ameliyat edilmiştir.

BULGULAR: Hastaların 726 (%67,3)’ı erkek, 353 (%32,7)’ü kadın olup yaş ortalaması 61,68+12,75 olarak hesaplanmıştır. Yapılan 1092 ameliyatın; 1048’i konvansiyonel, 44’ü çarpan kalpte  yapılmıştır. Hastaların 74 (%7)’ü reoperasyon hastasıydı. 59 hastaya bioprotez kullanıldı. Hastaların %61’i 60 yaş ve üzerinde, %44’ü 65 yaş ve üzerinde, %34’ü 70 yaş ve üzerinde, %19’u 75 yaş ve üzerinde ve %8’i 80 yaş ve üzerindeydi. Ortalama EuroSCORE  3,9+2,1 olarak hesaplanmıştır. Ortalama ejeksiyon fraksiyonu 43,53+12,15 (15-70) olarak hesaplanmıştır. 770 (%70,5) hastaya sadece koroner baypas, 121 (%11) hastaya sadece kapak, 115 (%10) hastaya koroner baypasa ilaveten konkomitant prosedür uygulandı. Postoperatif  morbidite olarak en sık atriyal fibrilasyon %11 oranında görülmüştür. Erken postoperatif mortalite 70 vaka ile %6,5 olarak hesaplanmıştır.

SONUÇ:  Kalp cerrahi bölümümüz  yeni kurulan bir merkez olmasına rağmen  vakalarını makul bir morbidite ve mortalite ile yapabilecek bir merkez haline gelmiştir.

Anahtar
kelimeler :  kardiyak cerrahi işlemler, koroner  cerrahisi

OBJECTIVE: Ebulfez Elcibey
Cardiovascular Surgery Clinic of Ankara Training and Education Hospital has
been established in 2012 and first open heart operation done on 17 July 2012.
In this report we have evaluated our operative results of the  literature.

MATERIAL AND METHODS: Between the dates 17
July 2012 – 15 July 2016, 1092 heart operation to 1079 patients has been done.
Data of patients have been recovered from pump forms ,echocardiography reports
and hospital records.

In
96% of cases conventional cardiopulmonary bypass technique has been apllied. 3%
of patients underwent heart valve operation using cardiopulmonary bypass on
beating heart. In 1% of patients off-pump beating heart coronary bypass was
done.

RESULTS: 726 (%67,3) of patiens were male and 353 (%32,7) of them were
female. Aveage age was 61,68+12,75. 1048 of the 1092
operation were conventional open heart operation and 44 of them were beating
heart. There were 74 (% 7) reoperation. In 59 patients bioprosthetic heart
valve has been used. 61%  of patiens were
above age 60, 44% above age 65, 34% above 70, 19% above 75 and 8% above age 80
years . Median EuroSCORE values have been estimated to be 3,9±2,1.

770
(%70,5) patient had only coronary bypass Most common morbidity was atrial
fibrilation with rate of 11%. Early postoperative mortality was 6,5% with 70
patients.

CONCLUSION: Our cardiovascular surgery
department although newly established has been succesfully accomplished very
complicated cardiac and aortic surgical cases with very low and acceptable
mortality and morbidity.

 Key words: Cardiac surgical procedures, coronary surgery.

Anahtar Kelimeler

KARDİYAK CERRAHİ İŞLEMLER, KALP KAPAK CERRAHİSİ, KORONER

Kaynakça

• 1) Gibbon JH. Application of a mechanical heart and lung apparatus to cardiac surgery, in Recent Advences in Cardiaovascular Physiology and Surgery Minneapolis: University of Minnesota, 1953;pp107-13.
• 2) Aytaç A. Dünyada ve Türkiye’de kalp cerrahisi. Türk Göğüs Kalp Damar Cer Derg 1991;1:8-12.
• 3) Çiçekçioğlu F, Kervan Ü, Parlar Aİ, Ersoy Ö, Bardakçı H, Ulus AT, Katırcıoğlu SF, Birincioğlu CL. The efficacy of amiodarone in the treatment of atrial fibrillation occurring after coronary bypass surgery. Turkish J Thorac Cardiovasc Surg 2009;17(2):77-82.
• 4) Hamulu A, Özbaran M, Atay Y, Posacıoğlu H, Aras İ, Büket S, Alayunt A, Bilkay Ö, Telli A, Durmaz İ. Bypass Ameliyatında Mortalite ve Morbiditeye Etki Eden Risk faktörlerinin Belirlenmesi ve Değerlendirilmesi. GKD Cer Derg 1995;3:245-252.
• 5) Yau TM, Fedak PW, Weisel RD, Teng C, Ivanov J. Predictors of operative risk for coronary bypass operations in patients with left ventricular dysfunction. J Thorac Cardiovasc Surg. 1999;118(6):1006.
• 6) Pires LA, Wagshal AB, Lancey R, Huang SK. Arrhythmias and conduction disturbances after coronary artery bypass graft surgery: epidemiology, management, and prognosis. Am Heart J. 1995; 129(4): 799.
• 7) Fortescue EB, Kahn K, Bates DW. Development and validation of a clinical prediction rule for major adverse outcomes in coronary bypass grafting. Am J Cardiol. 2001;88(11):1251.
• 8) Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. European Journal of Cardio-thoracic Surgery 15 (1999); 816-823.
• 9) Nashef SA, Roques F, Michel P, European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 16(1999);9-13.
• 10) Nashef SA, Roques F, Hammill BG, Peterson ED, Michel P, Grover FL, Wyse RK, Ferguson T. Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg. 2002;22(1):101.
• 11) Fariñas MC, Gald Peralta F, Bernal JM, Rabasa JM, Revuelta JM, González-Macías J. Suppurative mediastinitis after open-heart surgery: a case-control study covering a seven-year period in Santander, Spain. Clin Infect Dis. 1995;20(2):272.
• 12) El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996;61(3):1030.
• 13) Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg. 2010;89(5):1502).
• 14) Yokoyama Y, Chaitman BR, Hardison RM, Guo P, Krone R, Stocke K, Gussak I, Attubato MJ, Rautaharju PM, Sopko G, Detre KM. Association between new electrocardiographic abnormalities after coronary revascularization and five-year cardiac mortality in BARI randomized and registry patients. Am J Cardiol. 2000;86(8):819.
• 15) Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass.Blood. 1990;76(9):1680.
• 16) Katırcıoğlu SF, Çiçekcioğlu F, Tütün U, Parlar AI, Babaroglu S, Mungan U, Aksoyek A. On-pump beating heart mitral valve surgery without cross-clamping the aorta. J Card Surg. 2008 Jul-Aug;23(4): 307-11.
• 17) Selnes OA, Gottesman RF, Grega MA, Baumgartner WA, Zeger SL, McKhann GM. Cognitive and neurologic outcomes after coronary-artery bypass surgery. N Engl J Med. 2012 Jan;366(3):250-7.