Tip 2 diyabetik hastalarda koroner cerrahi sonrası, aortik çapın mortalite üzerine etkisinin araştırılması: klinik deneyimimiz

Amaç: Valvüler patolojisi olmayan normal sınırlarda kabul edilen aortik sinotubular junctional çap SJD ' a sahip Tip 2 diyabetik hastalarda, SJD' si üst elli persentilde kalanlar ile alt elli persentilde kalanların, Koroner arter bypas greft operasyonu KABGO sonrasında görülen mortalitelerindeki farkın istatiksel anlamlığı araştırıldı. Yöntem: : Ocak 2008 – Ağustos 2011 tarihleri arasında, Kalp ve Damar Cerrahisi KVC Kliniğinde, Assending aorta çapı cerrahi sınırın altında olan

Anahtar Kelimeler:

Tip 2 Diyabet, Koroner Arter Bypas Greftleme, Torasik Aorta, Mortalite oranı.

Investigating of Aortic Diameter affect on Mortality in Type 2 Diabetic Patients after Coronary Surgery: in our clinic experience

Objective: To compare the patients with a sinotubular junction diameter SJD in the upper percentile and those with a SJD in the lower percentile in terms of the mortality rates following coronary artery bypass grafting CABG among type 2 diabetic patients with a SJD within the normal limits who had no valvular pathology. Method: One hundred and fifty-five type 2 diabetic patients with an ascending aorta diameter below the surgical limit 3.1 cm constituted Group 2. Deaths within 30 days following the surgery were included in the study. Results: Two patients in Group 1, four patients in Group 2 died. The causes of death were massive ischemic encephalopathy in one patient, multi-organ failure in three patients, and low cardiac output syndrome in two patients. Conclusion: There was no significant difference between Group 1 and Group 2 patients in terms of mortality rates after CABG 2/72 vs. 4/83, p=0.686 .

Keywords:

Type 2 Diabet, Coronary Artery Bypass Grafting, Thoracic Aorta, Mortality Rate,

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Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enter- prises: part I: aging arteries: a “set up” for vascular disease. Circulation 2003; 107: 139-46.
Lakatta EG, Mitchell JH, Pomerance A, Rowe GG. Human aging: changes in structure and function. J Am Coll Cardiol 1987; 10(2 Suppl A ):42-7.
Nichols WW, O’Rourke MF. McDonald’s Blood Flow in Arteries. 5th edition. London: Arnold; 2005.
O’Rourke MF, Nichols WW. Aortic diameter, aor- tic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension ;45:652-8. Kuller LH. Stroke and diabetes. Diabetes in Amer- ica. 2th edition. Bethesda: The National Diabetes Information Clearinghouse (NDIC) of NIDDK; 1995.
Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. guideline update for coronary artery bypass graft surgery: a report of the American Colloge of Cardi- ology/American Heart Association task Force on Practice Guidelines (Committee to Update the 1999
Guidelines for Coronary Artery Bypass Graft Sur- gery). Circulation 2004;110:340-437.
Liotta D, Cooley DA, del Rio M, Safi HJ, Cabrol C, Pham SM, et al. A practical Textbook of Congenital and Acquired Diseases of the Aorta. Intelligent De- sign Aortic Root: Anatomy and Physiology. 2nd edition. University of Morón; 2003.
Van Der Linden J, Bergman P, Hadjinikolaou L. The topography of aortic atherosclerosis enhances its precision as a predictor of stroke. Ann Thorac Surg 2007; 83: 2087-92.
Acartürk E, Ozeren A, Sanca Y. Detection of aortic plaques by transesophageal echocardiography in patients with ischemic stroke. Acta Neurol Scand ; 92: 170-2. Olson LJ, Subramanian R, Edwards WD. Surgical pathology of pure aortic insufficiency: a study of cases. Mayo Clin Proc 1984; 59: 835-41.
Franklin SS, Gustin Wt, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D. Hemodynamic pat- terns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997; 96: 308
Franklin SS, Jacobs MJ, Wong ND, L’Italien GJ, Lapuerta P. Predominance of isolated systolic hy- pertension among middle-aged and elderly US hy- pertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hyper- tension 2001; 37: 869-74.
Mitchell GF, Pfeffer MA. Pulsatile hemodynam- ics in hypertension. Curr Opin Cardiol 1999; 14: 361- ACC/AHA 2004
Dart AM, Kingwell BA. Pulse pressure–a review of mechanisms and clinical relevance. J Am Coll Cardiol 2001; 37: 975-84.
Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enter- prises: Part I: aging arteries: a “set up” for vascular disease. Circulation 2003; 107: 139-46.
Stefanadis C, Stratos C, Vlachopoulos C, Marakas S, Boudoulas H, Kallikazaros I, et al. Pressure- diameter relation of the human aorta. A new meth- od of determination by the application of a special ultrasonic dimension catheter. Circulation 1995; 92: 9.
Kelly RP, Tunin R, Kass DA. Effect of reduced aortic compliance on cardiac efficiency and contrac- tile function of in situ canine left ventricle. Circ Res ; 71: 490-502. Cohen GI, White M, Sochowski RA, Klein AL, Bridge PD, Stewart WJ, et al. Reference values for normal adult transesophageal echocardiographic measurements. J Am Soc Echocardiogr 1995; 8: 221
Aronow WS, Fleg JL. Cardiovascular disease in the elderly. 5th edition. New York: Marcel Dekker Inc; 2004.
Schlatmann TJ, Becker AE. Pathogenesis of dis- secting aneurysm of aorta. Comparative histopatho- logic study of significance of medial changes. Am J Cardiol 1977; 39: 21-6.
Loukas M, Wartmann CT, Tubbs RS, Apaydin N, Louis RG Jr, Easter L, et al. The clinical anatomy of the sinotubular junction. Anat Sci Int 2009; 84: 27
Juutilainen A, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Similarity of the impact of type 1 and type 2 diabetes on cardiovascular mortality in the middle-aged subjects. Diabetes Care 2008; 31: 714
Peppa M, Uribarri J, Vlassara H. The role of ad- vanced glycation end-products in the development of atherosclerosis. Curr Diab Rep 2004; 4: 31-6.
Calcutt NA, Cooper ME, Kern TS, Schmidt AM. Therapies for hyperglycaemia-induced diabetic complications: from animal models to clinical trials. Nat Rev Drug Discov 2009; 8: 417-29.
McClung JA, Naseer N, Saleem M, Rossi GP, Weiss MB, Abraham NG, et al. Circulating endothe- lial cells are elevated in patients with type 2 diabe- tes mellitus independently of HbA(1)c. Diabetologia ; 48: 345-50.