Koroner Arter Baypas Cerrahisi Sırasında Yapılan Kan Transfüzyonunun Hastane Mortalitesi Üzerine Etkisi

Yıl 2019, Cilt: 22 Sayı: 1, 1 - 6, 11.04.2019

Mehmet Kalender , Ahmet Nihat Baysal Mustafa Dağlı Mehmet Orkun Şahsıvar Hayat Gökmengil

Öz

Giriş: Kan transfüzyonu kalp cerrahisinde hayat kurtarıcı olabildiği gibi ölümcül de olabilmektedir. Son
yıllarda kan ürünlerinin kullanımının azaltılması yönünde deliller artmıştır. Kan ürünlerinin hem erken dönem
hem de geç dönem artmış mortalite ile birlikteliğini destekleyen pek çok yazı mevcut. Ancak transfüzyonun
açık kalp cerrahisi uygulanan hastalarda hangi aşamada daha tehlikeli olduğuna dair delil az bulunmaktadır.
Bu sebeple biz intraoperatif kan transfüzyonu uygulanmış hastalarda görülen mortalite oranı ile postoperatif
kan transfüzyonu uygulanmış hastalarda görülen mortaliteyi kıyasladık.
Hastalar ve Yöntem: Çalışma Nisan 2008 ve Şubat 2013 tarihlerinde 108 (%78.8)’i erkek, 29 (%21.2)’u kadın
olmak üzere toplam 137 olgu ile yapılmıştır. Çalışmaya dahil ettiğimiz hastalarda kardiyopulmoner baypas
(KPB) sırasında hedef hematokrit %20-25 KPB sonrasıda hedef %25-%30 olarak belirlendi. Postoperatif
dönemde hastalarımızda eğer anemiye sekonder semptom yok ise hedef hematokrit %26’nın üzeri olarak
belirlendi. Ancak semptomatik hastalarda semptom giderilmesi hedeflendi. Taze donmuş plazma (TDP)
sadece hacim genişletmek için değil ayrıca koagülapatinin düzeltilmesi içinde kullanıldı. Anemi düzeltilmesi
için sadece eritrosit süspansiyonu (ES) transfüzyonu sağlandı.
Bulgular: Çalışma 108 (%78.8)’i erkek, 29 (%21.2)’u kadın olmak üzere toplam 137 olgu ile yapılmıştır.
Olguların yaşları 36 ile 82 yıl arasında değişmekte olup, ortalama yaş 60.88 ± 9.84 yıldır. Olguların 109
(%79.6)’u yaşamakta iken, 28 (%20.4)’i eksitus olmuştur. Operasyon sırasında kullanılan eritrosit miktarı iki
ve daha fazla olduğunda eksitusu öngörmedeki duyarlılığı %46.43, özgüllüğü %81.65, pozitif kestirim değeri
%36.39 ve negatif kestirim değeri %85.58 saptanmıştır.
Sonuç: Baypas uygulanan hastalarda intraoperatif transfüzyon hastane mortalitesi üzerine olumsuz etkisi
mevcut. Bu haliyle peroperatif dönemde tranfüzyondan kaçınmak için gerekli önlemlerin alınması uygun olur.

Anahtar Kelimeler

Kan transfüzyonu, kalp cerrahisi, mortalite

Effects of Blood Transfusion on Hospital Mortality During Coronary Artery Bypass Grafting

Öz

Introduction: Blood transfusion in cardiac surgery patients may cause mortality although it is a life saver
under specific conditions. Recently published papers advocate that reduction in blood products due to transfusion caused early and long-term mortality. In cardiac surgery patients, it is unclear as to which period of perioperative transfusion is more hazardous. Here, we studied perioperative mortality according to transfusion.
Patients and Methods: A total of 137 patients (29 female) were enrolled between April 2008 and February
2013. Target hematocrit levels during cardiopulmonary bypass were (HTC) 20%-25%, and post cardiopulmonary bypass target hematocrit levels were 25%-30%. During postoperative follow-up, transfusion was
performed if patients had symptoms due to anemia. Otherwise, the lowest postoperative target hematocrit
level was 26%. Fresh frozen plasma was used either for volume expansion or for coagulopathy correction. For
anemia correction, only erythrocyte suspension was used.
Results: A total of 137 patients participated in this study. Of those 137, 108 were male (78.8%). The mean
age of the patients in the study group was 60.88 ± 9.84 (range, 36-82) years. Hospital mortality was observed
in 28 (20.4%) patients. Intraoperative 2 or more transfusion of erythrocyte suspension has 81.65% specificity
and 46.43% sensitivity to predicts mortality.
Conclusion: Intraoperative transfusion during cardiopulmonary bypass negatively affects hospital mortality.
Hence, necessary precautions should be taken to avoid transfusion.

Anahtar Kelimeler

Blood transfusion, cardiac surgery, mortality

Kaynakça

• 1. Ranucci M, Aronson S, Dietrich W, Dyke CM, Hofmann A, Karkouti K, et al. Patient blood management during cardiac surgery: do we have enough evidence for clinical practice? J Thorac Cardiovasc Surg 2011;142:249.e1-32.
• 2. Westenbrink BD, Kleijn L, de Boer RA, Tijssen SG, Warnica WJ, Baillot R, et al. Sustained postoperative anaemia is associated with an impaired outcome after coronary artery bypass graft surgery: insights from the IMAGINE trial. Heart 2011;97:1590-6.
• 3. Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G. Surgical and Clinical Outcome Research (SCORE) Group. Major bleeding, transfusions, and anemia: The deadly triad of cardiac surgery. Ann Thorac Surg 2013;96:478-85.
• 4. Jakobsen CJ, Ryhammer PK, Tang M, Andreasan JJ, Mortensen PE. Transfusion of blood during cardiac surgery is associated with higher long-term mortality in low-risk patients. Eur J Cardiothorac Surg. 2012;42:114-20.
• 5. Mikkola R, Heikkinen J, Lahtinen J, Paone R, Juvonen T, Biancari F. Does blood transfusion affect intermediate survival after coronary artery bypass surgery? Scand J Surg 2013;102:110-6.
• 6. Leal-Noval SR, Rincón-Ferrari MD, García-Curiel A, Herruzo-Avilés A, Camacho-Laraña P, Garnacho-Montero J, et al. Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest 2001;119:1461-8.
• 7. Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006;34:1608-16.
• 8. Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ, et al. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg 2006;81:1650-7.
• 9. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008;358:1229-39.
• 10. Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007;116:2544-52.
• 11. Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham S. Effect of blood transfusio on long-term survival after cardiac operation. ANN Thorac Surg 2002;74:1180-6.
• 12. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;340:409-17.
• 13. Shaw RE, Johnson CK, Ferrari G, Zapolanski A, Brizzio M, Rioux N, et al. Balancing the benefits and risks of blood transfusions in patients undergoing cardiac surgery: a propensity-matched analysis. Interact Cardiovasc Thorac Surg 2013;17:96-102.
• 14. De Santo LS, Amarelli C, Della Corte A, Scardone M, Bancone C, Carozza A, et al. Blood transfusion after on-pump coronary artery bypass grafting: focus on modifiable risk factors. Eur J Cardiothorac Surg 2013;43:359-66.
• 15. dos Santos AA, Sousa AG, Thomé HOS, Machado RL, Piotto RF. Impact on early and late mortality after blood transfusion in coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc 2013;28:1-9.
• 16. Karkouti K, O’Farrell R, Yau TM, Beattie WS; Reducing Bleeding in Cardiac Surgery Research Group. Prediction of massive blood transfusion in cardiac surgery. Can J Anaesth 2006;53:781-94.
• 17. Simeone F, Franchi F, Cevenini G, Marullo A, Fossombroni V, Scolletta S, et al. A simple clinical model for planning transfusion quantities in heart surgery. BMC Med Inform Decis Mak 2011;11:44.
• 18. Ferraris VA, Ferraris SP, Saha SP, Hessel EA, Haan CK, Royston BD, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 2007;83:S27-86.
• 19. Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011;91:944-82.
• 20. Demirok M, Askin D, Emin I. Autologous blood transfusions during the bypass and valve operations. Türk Gögüs Kalp Damar Cer Derg 2005;13:193-6.
• 21. Bilecen S, de Groot JAH, Kalkman CJ, Spanjersberg AJ, Moons KGM, Nierich AP. Effectiveness of a cardiac surgery–specific transfusion protocol. Transfusion 2014;54:708-16.