Seksen Yaş Ve Üzeri Hastalarda Açık Kalp Cerrahisi: İki Farklı Dönemin Karşılaştırılması

Yıl 2022, Cilt: 32 Sayı: 3, 330 - 334, 01.08.2022

Veysel Başar Ayhan Güneş Gürkan Ayaz Mehmet Erdem Toker

https://doi.org/10.54005/geneltip.1082601

Öz

Amaç: Çalışmada, açık kalp cerrahisi geçiren octogenarian hastalarda, ameliyat sonuçları açısından iki farklı dönemin karşılaştırılması amaçlandı.

Materyal ve metod: Kliniğimizde Ocak 2013 - Aralık 2020 yılları (grup 1:115 hasta) ile Ocak 2000 - Aralık 2007 yılları (grup 2:103 hasta) arasında açık kalp cerrahisi geçirmiş 80 yaş ve üstü 218 hasta çalışmaya dahil edilmiş ve iki gruba ayrılmıştır. Çalışma retrospektif tasarlanmış olup, iki grup arası operatif ve postoperatif veriler istatistiksel olarak karşılaştırılmıştır.

Bulgular: Gruplar arasında yaş ortalamaları ve cinsiyet dağılımları açısından istatistiksel olarak anlamlı bir farklılık bulunmamaktadır (p>0.05). Grup 2’de CABG-BH oranı (%24.5), Grup 1’den (%7.9) istatistiksel olarak anlamlı düzeyde yüksektir (p:0.002; p<0.05). Grup 1’de AVR oranı (%53.9), Grup 2’den (%10.7) istatistiksel olarak anlamlı düzeyde yüksektir (p:0.000; p<0.05). Grup 1’de mitral tamir oranı (%7.1), Grup 2’den (%1) istatistiksel olarak anlamlı düzeyde yüksektir (p:0.037; p<0.05). Grup 1’in preop ejeksiyon fraksiyonu (EF) düzeyi ortalaması, Grup 2’den istatistiksel olarak anlamlı düzeyde yüksektir (p:0.000; p<0.05). Grup 2’de lima oranı (%68), Grup 1’den (%29.8) istatistiksel olarak anlamlı düzeyde yüksektir (p:0.000; p<0.05). Kanama revizyonu, postoperatif serebrovaskuler olay ve mortalite açısından gruplararası istatistiksel anlamlı fark bulunmamıştır. En sık mortalite nedeni kardiyak nedenlerdir.

Sonuç: Seksen yaş ve üzeri hastalarda açık kalp cerrahisi, yüksek mortalite ve kabul edilebilir morbidite oranlarına sahiptir. Klinik deneyimin artması, tamir ve minimal invaziv tekniklerin gelişmesiyle birlikte, doğru hasta seçimi ve eşlik eden ek hastalıkların varlığında seçilecek uygun cerrahi yaklaşım ile daha düşük mortalite oranları sağlanabilir.

Anahtar Kelimeler

açık kalp cerrahisi, seksen yaş ve üzeri, aort kapak replasmanı, mitral kapak replasmanı, koroner arter bypass greftleme, aort anevrizması

Destekleyen Kurum

yok

Open Heart Surgery In Octogenarian Patients: A Comparison Of Two Eras

Öz

Aim: In this study, it was aimed to compare two different periods in terms of surgical results in octogenarian patients who underwent open heart surgery.

Material and method: In the present study, 218 patients aged 80 and over who had undergone open heart surgery in our clinic between January 2013 and December 2020 (group 1:115 patients) and between January 2000 and December 2007 (group 2:103 patients) were included and divided into two groups. The study was designed retrospectively, and the operative and postoperative data were statistically compared between the two groups.

Results: There was no significant difference between groups in terms of mean age and gender distribution (p>0.05). Coronary artery bypass graft-beating heart prevalence in Group 2 (24.5%) was significantly higher than that in Group 1 (7.9%) (p:0.002; p<0.05). Aorta valve replacement rate in Group 1 (53.9%) was significantly higher than that in Group 2 (10.7%) (p:0.000; p<0.05). Mitral repair rate in Group 1 (7.1%) was significantly higher than that in Group 2 (1%) (p:0.037; p<0.05). The mean preop ejection fraction level of Group 1 was significantly higher than that in Group 2 (p:0.000; p<0.05). Left internal mammary artery prevalence in Group 2 (68%) was significantly higher than that in Group 1 (29.8%) (p:0.000; p<0.05). There was no statistically significant difference between groups in terms of bleeding revision, postoperative cerebrovascular event, and mortality. The most common cause of mortality was cardiac in origin.

Conclusion: Open heart surgery in octogenarian patients has high mortality and acceptable morbidity rates. With the increase in clinical experience and the development of repair and minimally invasive techniques, lower mortality rates can be achieved with the right patient selection and an appropriate surgical approach in the presence of comorbidities.

Anahtar Kelimeler

open heart surgery, aortic valve replacement, mitral valve replacement, octogenarian patients, aortic aneurysm

Kaynakça

• 1. Assey ME. Heart disease in the elderly. Heart Dis Stroke 1993;2:330-4
• 2. Shah VZ, Rosenfeldt FL, Parkin GW, Ugoni AM, Habersberger PG, Cooper E. Cardiac surgery in the very elderly. Med J Aust 1994;160:332-4
• 3. Unger F. The changing image in cardiac surgery. J Cardiovasc Surg (Torino) 1994;35(6 Suppl 1):1-5
• 4. Parant A. Demographic trends in Europe. Futuribles 1993;(175):43-55. [Abstract]
• 5. Tsai TP, Chaux A, Matloff JM, Kass RM, Gray RJ, DeRobertis MA, et al. Ten-year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg 1994;58:445-50
• 6. Edmunds LH, Stephenson LW, Eddie RN, Ractliffe MB. Openheart surgery in octagenarians. N Eng J Med 1988;139: 131-6
• 7. Kawachi Y, Nakashima A, Toshima Y, Kimura S, Arinaga K. Outcome of cardiac and thoracic aortic operation in patients over 80 years old. Asian Cardiovasc Thorac Ann 2002;10:12-15.
• 8. U.S. Census Bureau, 2007. Available from: http://www.census.gov Erişim tarihi 26.07.2007.
• 9. Türkiye İstatistik Kurumu, www.tuik.gov.tr
• 10. Akins CW, Daggett WM, Vlahakes GJ, Hilgenberg AD, Torchiana DF, Madsen JC, et al. Cardiac operations in patients 80 years old and older. Ann Thorac Surg 1997;64:606-14.
• 11. Arbatli H, Unal M, Demirsoy E, Tansal S, Yağan N, Tükenmez F, et al. Coronary bypass surgery in octogenarians. [Article in Turkish] Anadolu Kardiyol Derg 2001;1:156-63.
• 12. Kolh P, Kerzmann A, Lahaye L, Gerard P, Limet R. Cardiac surgery in octogenarians; peri-operative outcome and longterm results. Eur Heart J 2001;22:1235-43.
• 13. Kirsch M, Guesnier L, LeBesnerais P, Hillion ML, Debauchez M, Seguin J, et al. Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 1998;66:60-7.
• 14. Stoica SC, Cafferty F, Kitcat J, Baskett RJ, Goddard M, Sharples LD, et al. Octogenarians undergoing cardiac surgery outlive their peers: a case for early referral. Heart 2006;92:503-6.
• 15. Pierard LA. Cardiac surgery in octogenarians: who, when and how? Eur Heart J 2001;22:1159-61.
• 16. Johnson WM, Smith JM, Woods SE, Hendy MP, Hiratzka LF. Cardiac surgery in octogenarians: does age alone influence outcomes? Arch Surg 2005;140:1089
• 17. Freeman WK, Schaff HV, O'Brien PC, Orszulak TA, Naessens JM, Tajik AJ. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol 1991;18:29-35.
• 18. Dalrymple-Hay MJ, Alzetani A, Aboel-Nazar S, Haw M, Livesey S, Monro J. Cardiac surgery in the elderly. Eur J Cardiothorac Surg 1999;15:61-6.
• 19. Toker ME, Mataracı İ, Çalışkan A, Eren E, Erdoğan HB, Zeybek R, Balkanay M, Yakut C. Open heart surgery and results in patient population aged 80 years and older. Turkish journal of thoracic and cardiovascular surgery. 2009;17(3):151-156.
• 20. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451–96.
• 21. Ozen A, Unal EU, Songur M, Kocabeyoglu SS, Hanedan O et all. Coronary artery bypass grafting in the octogenarians: should we intervene, or leave them be? J Geriatr Cardiol 2015; 12: 147−152.
• 22. Khan H, Uzzaman M, Benedetto U, Butt S, G.Raja S. On- or off-pump coronary artery bypass grafting for octogenarians: A meta-analysis of comparative studies involving 27,623 patients. International Journal of Surgery 47 (2017) 42e5144.
• 23. Culliford AT, Galloway AC, Colvin SB, Grossi EA, Baumann FG, Esposito R, et al. Aortic valve replacement for aortic stenosis in persons aged 80 years and over. Am J Cardiol 1991;67:1256-60
• 24. Demir A, Pepeşengül E, Aydınlı B, Tezcan B, Eke H, et al. Cardiac surgery and anesthesia in an elderly and very elderly patient population: a retrospective study. Türk Göğüs Kalp Damar Cer Derg 2011;19(3):377-383.
• 25. Ko W, Krieger KH, Lazenby WD, Shin YT, Goldstein M, Lazzaro R, et al. Isolated coronary artery bypass grafting in one hundred consecutive octogenarian patients. A multivariate analysis. J Thorac Cardiovasc Surg 1991;102:53
• 26. Adkins MS, Amalfitano D, Harnum NA, Laub GW, McGrath LB. Efficacy of combined coronary revascularization and valve procedures in octogenarians. Chest 1995; 108:927-31.