Time-Dependent Effects of Normothermic and Mild Hypothermic Cardiopulmonary Bypass on the De Ritis Ratio

Yıl 2025, Cilt: 8 Sayı: 3, 265 - 270, 30.09.2025

Reşat Dikme

https://doi.org/10.36516/jocass.1745062

Öz

Aim: This study aims to comparatively evaluate the effects of normothermic and mild hypothermic cardiopulmonary bypass (CPB) strategies on liver function in coronary artery bypass grafting (CABG) operations through the dynamics of the De Ritis ratio.
Methods: This retrospective study included 150 patients who underwent CABG with either normothermic (35–37 °C, n=75) or mild hypothermic (28–34 °C, n=75) CPB. Liver function parameters (AST, ALT, De Ritis ratio, GGT, bilirubin) were assessed at the prebypass, postbypass, and postoperative time points. Statistical analysis was performed using SPSS software, with significance set at p<0.05.
Results: While De Ritis ratios were comparable during the prebypass period (p=0.751), significantly higher values were observed in the mild hypothermic group during both the postbypass (p=0.032) and postoperative (p=0.048) periods. A significant time-dependent increase in De Ritis ratio was found in both groups (p<0.01). Moreover, a higher proportion of patients in the mild hypothermic group had a De Ritis ratio >2.0 in the postoperative period. The De Ritis ratio showed a negative correlation with GGT at all time points (p<0.001) and a positive correlation with total bilirubin during the prebypass (p<0.001) and postoperative (p=0.006) periods. Female patients consistently showed higher De Ritis ratios than males (p < 0.05).
Conclusion: The normothermic CPB strategy was associated with lower De Ritis ratios compared to hypothermia. The De Ritis ratio may serve as an early indicator of liver function in cardiovascular surgery. Normothermic perfusion may offer hepatoprotective benefits and could be preferred in patients at high risk for liver dysfunction.

Anahtar Kelimeler

Cardiopulmonary bypass , Normothermia , Hypothermia , De Ritis ratio , AST/ALT , Hepatic injury

Normotermik ve Hafif Hipotermik Kardiyopulmoner Bypass'ın De Ritis Oranı Üzerindeki Zamana Bağlı Etkileri

Öz

Amaç: Bu çalışma, koroner arter bypass greftleme (KABG) operasyonlarında normotermik ve hafif hipotermik kardiyopulmoner bypass (KPB) stratejilerinin karaciğer fonksiyonu üzerindeki etkilerini De Ritis oranının dinamikleri üzerinden karşılaştırmalı olarak değerlendirmeyi amaçlamaktadır.

Yöntem: Retrospektif olarak tasarlanan bu çalışmaya, normotermik (35–37 °C, n=75) veya hafif hipotermik (28–34 °C, n=75) KPB altında KABG uygulanan toplam 150 hasta dâhil edilmiştir. Karaciğer fonksiyon parametreleri [AST, ALT, De Ritis oranı (AST/ALT), GGT ve bilirubin] prebypass, postbypass ve postoperatif dönemlerde değerlendirilmiştir. İstatistiksel analizler SPSS yazılımı kullanılarak gerçekleştirilmiş ve anlamlılık düzeyi p<0,05 olarak kabul edilmiştir.

Bulgular: Prebypass döneminde gruplar arasında De Ritis oranları benzer bulunmuşken (p=0,751), postbypass (p=0,032) ve postoperatif (p=0,048) dönemlerde hipotermik grupta anlamlı şekilde daha yüksek değerler gözlenmiştir. Her iki grupta da zamana bağlı olarak De Ritis oranında anlamlı bir artış saptanmıştır (p<0,01). Ayrıca, postoperatif dönemde hipotermik grupta De Ritis oranı >2,0 olan hasta oranı daha yüksek bulunmuştur. De Ritis oranı tüm zaman noktalarında GGT ile negatif korelasyon göstermiştir (p<0,001); prebypass (p<0,001) ve postoperatif (p=0,006) dönemlerde ise total bilirubin ile pozitif korelasyon saptanmıştır. Kadın hastalarda De Ritis oranı her zaman diliminde erkeklere göre anlamlı şekilde daha yüksek bulunmuştur (p<0,05).

Sonuç: Normotermik KPB stratejisi, hipotermiye kıyasla daha düşük De Ritis oranları ile ilişkilendirilmiştir. De Ritis oranı, kardiyovasküler cerrahide karaciğer fonksiyonunun erken bir belirteci olarak değerlendirilebilir. Normotermik perfüzyon, hepatoprotektif etkiler sağlayabilir ve karaciğer fonksiyon bozukluğu riski yüksek olan hastalarda tercih edilebilir.

Anahtar Kelimeler

Kardiyopulmoner bypass , Normotermi , Hipotermi , De Ritis oranı , AST/ALT , Hepatik hasar

Kaynakça

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