Açık kalp cerrahisi sonrası ıntraaortik balon pompası kullanılan hastalarda hastane mortalitesinde risk faktörleri

Yıl 2005, Cilt: 12 Sayı: 1, 11 - 16, 03.04.2009

İlker Kiriş

Öz

SüleymanDemirel Üniversitesi
TIP FAKÜLTESİ DERGİSİ: 2005 Mart; 12(1)


Açık kalp cerrahisi sonrası ıntraaortik balon pompası kullanılan hastalarda hastane mortalitesinde risk faktörleri


İlker Kiriş



Özet:

Intraaortik balon pompası (IABP), açık kalp cerrahisinde sık kullanılan, geçici dolaşımsal destek sağlayan mekanik bir cihazdır. Başlıca endikasyonları; kardiyojenik şok, kontrol edilemeyen miyokardiyal iskemik ağrı ve postkardiyotomi düşük kardiyak output durumudur. Bu retrospektif çalışmanın amacı, kliniğimizde açık kalp ameliyatı sonrasında IABP kullanılan hastalarda hastane mortalitesi için olası risk faktörlerini araştırmaktı. Kliniğimizde, Temmuz 2002-Haziran 2004 arasında, açık kalp ameliyatı sonrasında IABP kullanılan toplam 52 hasta çalışmaya alındı. Hastaların 42'si erkek (% 80.76), 10'u kadın (% 19.23) olup, erkek ve kadın hastaların yaşları sırasıyla ortalama 63.81 ± 10.06 ve 61.00 ± 12.42 (tüm hastaların ortalama yaşı 63.2 ± 10.4) idi. Eksitus olan hastalar (grup 1, n=20) ve hayatta kalan hastalara (grup 2, n=32) ait parametreler birbiri ile karşılaştırıldığında, diabetes mellitus (p=0.047), kardiyomegali (p=0.004), koroner arter hastalığına eşlik eden kalp kapak hastalığı (p=0.019), obesite (p=0.049), perfüzyon süresi (p= 0.00) ve aortik kros klemp süresi (p=0.026) değerleri açısından istatistiksel olarak anlamlı fark bulundu. Çalışmamız göstermiştir ki; açık kalp cerrahisi sonrası IABP kullanılan hastalarda, diabetes mellitus, kardiyomegali, koroner arter hastalığına eşlik eden kalp kapak hastalığı, obesite, uzamış perfüzyon süresi ve aortik kros klemp süresi, artmış hastane mortalitesine eşlik eden risk faktörleridir. Açık kalp cerrahisi sonrası IABP kullanılan hastalarda mortalite için önemli risk faktörlerinin açığa çıkarılması amacıyla daha fazla sayıda hastayı kapsayan yeni klinik çalışmaların yapılması uygundur.



Anahtar kelimeler: Intraaortik balon pompası, açık kalp cerrahisi, mortalite, risk faktörleri



Abstract



Risk Factors For Hospital Mortality In Patients Intraaortic Balloon Pump Used Following Open Heart Surgery

Intra-aortic balloon pump (IABP), providing temporary mechanical circulatory support, is a frequently used device in open heart surgery. Its main indications are cardiogenic shock, uncontrolled myocardial ischemic pain and postcardiotomy low cardiac output. The objective of this retrospective study was to determine the possible risk factors for hospital mortality in the patients IABP used following open heart surgery in our clinic. A total of 52 patients who underwent open heart operations between January 2002-June 2004 were included into the study. 42 (80.76 %) and 10 (19.23 %) of the patients were male and female, respectively. Mean age of the all patients was 63.2 ± 10.4 and mean age of the male and female patients was 63.81 ± 10.06 and 61.00 ± 12.42, respectively. When parameters of survived and not-survived patients were compared, there were statistically significant differences including diabetes mellitus (p=0.047), cardiomegaly (p=0.004), concomitant heart valve disease (p=0.019), obesity (p=0.049), perfusion period (p=0.00) and aortic cross clamp time (p=0.026). Our study showed that, diabetes mellitus, cardiomegaly, concomitant heart valve disease, obesity, prolonged perfusion period and aortic cross-clamp time can be associated with increased hospital mortality. New clinic studies with higher number of patients should be done to clarify important risk factors for mortality in patients IABP needed following open heart surgery.



Key words: Intraaortic balloon pumping, open heart surgery, mortality, risk factors

Anahtar Kelimeler

Intraaortik balon pompasý, açýk kalp cerrahisi, mortalite, risk faktörleri

Kaynakça

• Christenson JT, Buswell L, Velebit V, Maurice J, Simonet F, Schmuziger M. The Intraaortic Balloon Pump For Postcardiotomy Heart Failure. Experience With 169 Intraaortic Balloon Pumps. Thorac Cardiovasc Surg. 1995 Jun;43(3):129-33.
• Naunheim KS, Swartz MT, Pennington DG, et al. Intraaortic Balloon Pumping In Patients Requiring Cardiac Operations. Risk Analysis and Long-Term Follow-Up. J Thorac Cardiovasc Surg. 1992; 104:1654- 61.
• Arafa OE, Pedersen TH, Svennevig JL, Fosse E, Geiran OR. Intraaortic Balloon Pump In Open Heart Operations: 10-Year Follow-up With Risk Analysis. Ann Thorac Surg. 1998;65:741-747.
• Hausmann H, Potapov EV, Koster A, Krabatsch T, Stein J, Yeter R et all. Prognosis After The Implantation Of An Intra-Aortic Balloon Pump In Cardiac Surgery Calculated with A New Score. Circulation. 2002;106(suppl 1):1-203-1-206.
• Tokmakoðlu H, Farsak B, Günaydýn S, Kandemir Ö, Aydýn H, Yorgancýoðlu C ve ark. Effectiveness of Intraaortic Balon Pumping in Patients Who Were Not Able To Be Weaned From Cardiopulmonary Bypass After Coronary Artery Bypass Surgery and Mortality Predictors in the Perioperative and Early Postoperative Period. Anadolu Kardiol Derg. 2003 June;(3)2:124-8.
• Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes Mellitus Increases Short- Term Mortality and Morbidity In Patients Undergoing Coronary Artery Bypass Graft Surgery. J Am Coll Cardiol. 2002 Aug 7;(40)3:418-23.
• Pennington DG, Swartz M, Codd JE, Merjavy JP, Kaiser GC. Intra-Aortic Balloon Pumping In Cardiac Surgical Patients: A Nine Year Experience. Ann Thorac Surg. 1983;36:125-131.
• McEnany TM, Kay HR, Buckley MJ. Clinical Experience With Intra-Aortic Balloon Pump Support In 782 Patients. Circulation. 1978;58:1124-1132.
• Hausmann H, Topp H, Siniawski H, Holz S, Hetzer R. Decision-Making In End-Stage Coronary Artery Disease: Revascularization Or Heart Transplantation. Ann thorac Surg. 1997;64:1296-1302.
• Creswell LL, Rosenbloom M, Cox JL, Ferguson TB Sr, Kouchoukos NT, Spray TL et all. Intra-Aortic Balloon Counterpulsation Patterns Of Usage And Outcome In Cardiac Surgery Patients. Ann Thorac Surg. 1992;54:11-20.
• Ferguson JJ, Cohen M, Freedman RJ, Stone GW, Miller MF, Joseph et all. The Current Practice Of Intra-Aortic Balloon Counterpulsation: Results From The Benchmark Registry. J Am Coll Cardiol. 2001 Nov 1;38(5):1456-62.
• Christenson JT, Cohen M, Ferguson JJ, Freedman RJ, Miller MF, Ohman M et all. Trends In Intraaortic Balloon Counterpulsation Complications And Outcomes In Cardiac Surgery. Ann Thorac Surg. 2002;74:1086-1090.
• Christenson JT, Simonet F, Badel P, Schmuziger M. Optimal Timing Of Preoperative Intraaortic Balloon Pump Support In High-Risk Coronary Patients. Ann Thorac Surg. 1999;68:934-939.
• Arafa OE, Pedersen TH, Svennevig JL, Fosse E, Geiran OR. Vascular Complications Of The Intraaortic Balloon Pump In Patients Undergoing Open Heart Operations: 15-Year Experience. Ann Thorac Surg. 1999;67:645- 651.
• Meharwal ZS, Trehan N. Vascular Complications Of Intraaortic Balloon Insertion In Patients Undergoing Coronary Revascularization:Analysis Of 911 Cases. Eur J Cardiothorac Surg. 2002 Apr;21(4):741-7.