Kalp Cerrahisi Olan Hastalarda Minimal Ekstrakorporeal Dolaşım ve Konvansiyonel Dolaşım Sistemlerinin Karşılaştırılması

Öz

Giriş Amaç: Kalp cerrahisinde kardiyopulmoner bypass sırasında oluşan sistemik inflamatuar yanıt sendromu ve hemodilüsyon; morbitide ve mortalite üzerinde önemli birer etkendir. Bu sorunu azaltmaya yönelik ekstrakorporeal dolaşım sistemleri modifiye edilmiş ve minimal ekstrakorporeal dolaşım sistemi (MECC) olarak adlandırılmıştır. Çalışmamızda izole koroner arter bypass greft (KABG) cerrahisi geçiren hastalarda; MECC ile konvansiyonel ekstrakorporeal dolaşım sistemi kullanımını karşılaştırarak sonuçlarını paylaşmayı amaçladık. Materyal ve metod: Çalışma kliniğimizde 1 Eylül 2013 ile 31 Aralık 2018 tarihleri arasında izole KABG cerrahisi yapılan hastalar üzerinde retrospektif olarak yapıldı. Hastalar; MECC ekstrakorporeal dolaşım sistemi kullanılanlar (Grup 1) ve konvansiyonel ekstrakorporeal dolaşım sistemi kullanılanlar (Grup 2) olarak iki gruba ayrıldı. Bulgular: Çalışma MECC kullanılan 71 hasta (Grup 1), konvansiyonel ekstrakorporeal dolaşım sistemi kullanılan 69 hasta (Grup 2) olmak üzere toplam 140 hasta üzerinde yapıldı. MECC kullanılan grubun daha ileri yaşlı, kronik obstruktif akciğer hastalığının, ASA ve New York Kalp Derneği fonksiyonel sınıflama değerinin daha yüksek olduğu saptandı, p<0.05. Konvansiyonel ekstrakorporeal dolaşım sistemi kullanılan hastalarda aktive pıhtılaşma zamanı, priming solüsyonu, eritrosit transfüzyonu ve taze donmuş plazma transfüzyonu değerlerinin daha yüksektir, p < 0.05. Postoperatif veriler için yapılan karşılaştırmada grup 1’in hemotokrit değerinin yüksek, drenajın daha az ve kreatinin değerinin düşük ve entübasyon ile yoğun bakımda yatış süresinin daha kısa olduğu ve bu sonuçların istatiksel olarak anlamlı olduğu saptandı p<0.05. Sonuç: MECC sisteminin konvansiyonel sistem gibi güvenli ve kullanışlı bir ekstrakorporeal dolaşım sistemi olduğunu belirtebiliriz. Bu konuda daha fazla hasta sayısı ve prospektif çalışmalara da ihtiyaç vardır.

Anahtar Kelimeler

• Kalp cerrahisi
• kardiyopulmoner bypass
• Minimal Ekstrakorporeal Dolaşım Sistemi

Comparison of Minimal Extracorporeal Circulation and Conventional Circulatory Systems in Patients with Cardiac Surgery

Öz

Introduction and Aim: Systemic inflammatory response syndrome and hemodilution during cardiopulmonary bypass are important factors in morbidity and mortality. Extracorporeal circulatory systems were modified to reduce this problem and the minimal extracorporeal circulatory system (MECC) was developed. Our study aimed to compare the MECC and conventional extracorporeal circulatory systems in patients who underwent isolated coronary artery bypass graft (CABG) surgery. Materials and Methods: The study was conducted retrospectively on patients who underwent isolated CABG surgery in our clinic between September 1, 2013-December 31, 2018. The patients were divided into those in whom the MECC system (Group 1) and the conventional extracorporeal circulatory system (Group 2) were used. Results: The study was performed on a total of 140 CABG patients, 71 of which were performed with MECC (Group 1) and 69, with the conventional extracorporeal circulatory system (Group 2). Group 1 had higher mean age, ASA, and New York Heart Association values, and an increased rate of chronic obstructive pulmonary disease (p<0.05 for all). The activated clotting time, priming solution use, as well as the amounts of erythrocyte and fresh frozen plasma transfusion were higher in patients in whom the conventional extracorporeal circulatory system was used (p<0.05 for all). Postoperatively, the hematocrit value of Group 1 was higher, they had less drainage, and the creatinine value, and the length of intubated stay in the intensive care unit were shorter compared to Group 2 (p<0.05 for all). Conclusion: The MECC system is a safe and useful extracorporeal circulatory system, similar to the conventional system. However, further prospective studies with a higher number of patients are needed to confirm our results.

Anahtar Kelimeler

• Cardiac surgery
• Cardiopulmonary bypass
• minimal extracorporeal circulatory system

Kaynakça

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