Koroner Arter Baypas Greftleme Operasyonu Yapılan Hastalarda Postoperatif Komplikasyonların D Vitamini Seviyeleriyle İlişkisinin Retrospektif Değerlendirilmesi

Yıl 2022, Cilt: 1 Sayı: 3, 73 - 79, 30.12.2022

Izatullah Jalalzai Hakan Usta Ebubekir Sönmez İbrahim Pir Yasin Kılıç Ümit Arslan Merve Çetin Bilgehan Erkut

Öz

Giriş: Vasküler yapılar üzerindeki negatif etkileri nedeniyle düşük Vitamin D (VD) düzeyleri koroner arter hastalığı (KAH) için önemli bir risk faktörü kabul görmesine rağmen, VD eksikliğinin koroner arter baypas greftleme (KABG) operasyonlarının postoperatif komplikasyonları ile ilişkisi net değildir. Çalışmada KABG uygulanan hastalarda gelişen postoperatif komplikasyonlar ve VD seviyeleri arasındaki ilişkinin araştırılmasını amaçladık.
Metod: KABG operasyonu planlanan ve preoperatif dönemde VD seviyeleri ölçülmüş olan 150 hasta çalışmaya alındı. Veriler retrospektif incelenerek, VD seviyelerine göre 150 hasta kontrol grubu (Grup A; 25-80 ng/mL) ve VD eksikliği grubu (Grup B; <25ng/mL) olarak ikiye ayrıldı. Preoperatif, intraoperatif ve postoperatif veriler kaydedildi. İlk 30 gün içindeki ölümler mortalite, hospitalizasyon boyunca gelişen morbidite de komplikasyon olarak değerlendirildi.
Bulgular: VD düzeyi 25-80 ng/mL olan Grup A’da 75 hastanın (Erkek/Kadın;53/22) yaş ortalaması 60.2±9.2 ve VD değerleri <25 ng/mL olan Grup B’de 75 hastanın (Erkek/Kadın; 48/27) yaş ortalaması 62.08±8.9 idi. Cinsiyet (p=0,243), yaş (p=0,232), vücut kitle indeksi (VKI; p=0,137), EuroScore (p=0,512) açısından gruplar arasında fark yoktu. Ortalama VD seviyeleri Grup A’da 42.6±13.8 ng/mL ve Grup B’de 10.08±5.7 ng/mL ölçüldü. (p<0,01) Kardiyopulmoner baypas (KPB; p=0,874) ve aortik kros klemp (AKK; p=0,495) süreleri Grup B’de daha uzundu. Yapılan anastomoz sayısı Grup A’da 3,27±0.79 ortalama ile Grup B’den (2.80±0.88) daha fazlaydı (p=0,01) ancak Grup B’de daha çok hastada pozitif inotropik destek gereksinimi olduğu görüldü. (p=0,03) Kümülatif mortalite oranımız %3,3 (Grup A/B:2/3) tespit edildi.
Sonuç: VD’nin kardiyovasküler sistem üzerindeki etkileri göz önüne alındığında, VD eksikliğinin vasküler yapılarda yaptığı patolojik değişikliklerin KABG operasyonlarını daha komplike hale getirebileceği akılda tutulmalıdır. VD eksikliğinin postoperatif dönemde net etkilerinin belirlenmesi için prospektif ve geniş çaplı çalışmalara ihtiyaç olduğu görüşündeyiz

Anahtar Kelimeler

D vitamini, koroner arter hastalığı, koroner arter baypas greft, komplikasyon

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Retrospective Evaluation of Relationship between Postoperative Complications and Vitamin D Levels in Patients' performed Coronary Artery Bypass Grafting Operation

Öz

Objectives: Although low levels of Vitamin D (VD) are considered an important risk factor in coronary artery disease (CAD) due to its negative effects on vascular structures, the relationship between VD deficiency and postoperative complications of coronary artery bypass grafting (CABG) operations is not clear. In present study, we aimed to investigate the relationship between postoperative complications and VD levels in patients who underwent CABG.
Methods: 150 patients who were decided to have CABG operation and whose VD levels were measured in the preoperative period were included in the study. The data were analyzed retrospectively, and 150 patients were divided into control group (Group A; 25-80 ng/mL) and VD deficiency group (Group B; <25ng/mL) according to their VD levels. Preoperative, intraoperative and postoperative data were recorded. Deaths within the first 30 days were accepted as mortality and morbidity during hospitalization were accepted as complications.
Results: Group A consisted of 75 patients (Male/Female; 53/22) with a VD level of 25-80 ng/mL and mean age was 60.2±9.2 years, and Group B consisted of 75 patients (Male/Female; 48/27) with a VD value of <25 ng/mL and mean age was 62.08±8.9 years. There was no difference between the groups in terms of gender (p=0.243), age (p=0.232), BMI (p=0.137), and EuroScore (p=0.512). Mean of VD levels were 42.6±13.8 ng/mL in Group A and 10.08±5.7 ng/mL in Group B. (p<0.01) Cardiopulmonary bypass (CPB; p=0.874) and aortic cross-clamp (ACC; p=0.495) times were longer in Group B. The number of anatomoses was higher in Group A than Group B (3.27±0.79 and 2.80±0.88, respectively) (p=0.01) but the need for positive inotropic support was higher in Group B patients. (p=0.03) The cumulative mortality rate was 3.3% (Group A/B:2/3).
Conclusion: Considering the effects of VD on the cardiovascular system, it should be kept in mind that VD deficiency may make complicate CABG operations due to pathological changes in vascular structures. We think that prospective large-scale studies are needed to determine the net effects of VD deficiency in the postoperative period.

Anahtar Kelimeler

Vitamin D, coronary artery disease, coronary artery bypass graft, complication

Proje Numarası

yok

Kaynakça

• REFERANSLAR Referans1- Riley RF, Don CW, Powell W, Maynard C, Dean LS. Trends in coronary revascularization in the United States from 2001 to 2009: recent declines in percutaneous coronary intervention volumes. Circ Cardiovasc Qual Outcomes. 2011;4(2):193–7. DOI:10.1161/CIRCOUTCOMES.110.958744
• Referans2- Shahian DM, O'Brien SM, Normand ST, Peterson ED, Edwards, FH. Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score. J Thorac Cardiovasc Surg. 2010;139(2):273–82. DOI:10.1016/j.jtcvs.2009.09.007
• Referans3- Slamowicz R, Erbas B, Sundararajan V, Dharmage S. Predictors of readmission after elective coronary artery bypass graft surgery. Aust Health Rev. 2008;32(4):677-83. DOI:10.1071/ah080677
• Referans4- Hannan EL, Wu C, Ryan TJ, Bennett E, Culliford AT, Gold JP, et al. Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates? Circulation. 2003;108(7):795–801. DOI:10.1161/01.CIR.0000084551.52010.3B
• Referans5- Peterson ED, Coombs LP, DeLong ER, Haan CK, Ferguson TB. Procedural volume as a marker of quality for CABG surgery. JAMA 2004;291(2):195–201. DOI:10.1001/jama.291.2.195
• Referans6- Sachdev G, Napolitano LM. Postoperative pulmonary complications: pneumonia and acute respiratory failure. Surg Clin N Am. 2012;92(2):321–44. DOI:10.1016/j.suc.2012.01.013
• Referans7- Doğan M. , Doğan A. G. Vitamin D yetersizliği ve eksikliğine güncel yaklaşım. Journal of Health Sciences and Medicine. 2019;2(2): 58-61. DOI:10.32322/jhsm.496326
• Referans8- Roth DE, Abrams SA, Aloia J, Bergeron G, Bourassa MW, Brown KH, et al. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Annals of the New York Academy of Sciences. 2018;1430(1);44–79. DOI:10.1111/nyas.13968
• Referans9- Lee JH, O'Keefe JH, Bell D, Hensrud DD, Holick MF. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor? J Am Coll Cardiol. 2008;9;52(24):1949-56. DOI:10.1016/j.jacc.2008.08.050
• Referans10- Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Berisha AT, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr 2020;74:1498–1513. DOI:10.1038/s41430-020-0558-y
• Referans11- Wang L, Song Y, Manson J, Pilz S, März W, Michaëlsson K, et al. Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes. 2012;5:819–29. DOI:10.1161/CIRCOUTCOMES.112.967604
• Referans12- Kim D-H, Meza CA, Clarke H, Kim J-S, Hickner RC. Vitamin D and Endothelial Function. Nutrients. 2020;12(2):575. DOI:10.3390/nu12020575
• Referans13- Brøndum-Jacobsen P, Benn M, Jensen GB, Nordestgaard BG. 25-hydroxyvitamin d levels and risk of ischemic heart disease, myocardial infarction, and early death: population-based study and meta-analyses of 18 and 17 studies. Arterioscler Thromb Vasc Biol. 2012;32(11):2794-802. DOI:10.1161/ATVBAHA.112.248039.
• Referans14- Norman PE, Powell JT. Vitamin D and cardiovascular disease. Circ Res. 2014;17;114(2):379-93. DOI:10.1161/CIRCRESAHA.113.301241
• Referans15- Cosentino N, Campodonico J, Milazzo V, De Metrio M, Brambilla M, Camera M, et al. Vitamin D and Cardiovascular Disease: Current Evidence and Future Perspectives. Nutrients. 2021;13(10):3603. DOI:10.3390/nu13103603
• Referans16- Dziedzic EA, Przychodzeń S, Dąbrowski M. The effects of vitamin D on severity of coronary artery atherosclerosis and lipid profile of cardiac patients. Arch Med Sci. 2016;12(6):1199-1206. DOI:10.5114/aoms.2016.60640
• Referans17- Malhotra R, Das S, Choudhury M, Makhija N, Chauhan S, Lakhsmy R. Impact of pre-operative vitamin D deficiency on post-operative outcomes in adult cardiac surgery. Indian Journal of Clinical Anaesthesia 2022;9(3):304-9 DOI:10.18231/j.ijca.2022.062
• Referans18- Liu X, Wang W, Tan Z, Zhu X, Liu M, Wan R, et al. The relationship between vitamin D and risk of atrial fibrillation: a dose-response analysis of observational studies. Nutr J. 2019;14;18(1):73. DOI:10.1186/s12937-019-0485-8
• Referans19- Quraishi SA, McCarthy C, Blum L, Cobb JP, Camargo CA Jr. Plasma 25-Hydroxyvitamin D Levels at Initiation of Care and Duration of Mechanical Ventilation in Critically Ill Surgical Patients. JPEN J Parenter Enteral Nutr. 2016;40(2):273-8. DOI:10.1177/0148607114566276
• Referans20- Zittermann A, Kuhn J, Ernst JB, Becker T, Dreier J, Knabbe C, et al. 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and postoperative outcome in cardiac surgery. J Clin Endocrinol Metab. 2015;100(1):72-80. DOI:10.1210/jc.2014-3013
• Referans21- Tekeli Kunt A, Tümer NB, Özışık K, Günaydın S. Preoperative Vitamin D Level Predicts Operative Mortality After Cardiac Surgery. EJCM. 2020;8(3):146-151. DOI:10.32596/ejcm.galenos.2020.08.043