Açık Kalp Cerrahisi Sonrası Gelişen Düşük Kalp Debisi

Kalbin dakikada pompaladığı kan hacmi olarak tanımlanan kalp debisi kardiyak performansın değerlendirilmesinde göz önüne alınan en önemli hemodinamik parametrelerden biridir. Açık kalp cerrahisi sonrası hemodinaminin korunması ve yeterli kardiyak performansın sağlanması her zaman kolay olmayabilir. Düşük kalp debisi (DKD) de kardiyak cerrahi sonrası görülebilen ve ciddi hemodinamik değişikliklere yol açarak erken ve geç dönem mortalite ve morbiditeyi artıran durumlardan biridir. Bu derlemede, literatürler eşliğinde DKD’nin öneminin ve yönetiminin gözden geçirilmesi amaçlanmıştır.

Low Cardiac Output Developed After Open Cardiac Surgery

Cardiac output, described as the amount of blood pumped by heart in a minute, is one of the most important hemodynamic parameters for the assesment of cardiac performance. Preserving hemodynamic stability and sufficient cardiac performance may not always be easy after open cardiac surgeries. Low cardiac output (LCO) is one of the complications that can be observed after cardiac surgery and increase the risk of morbidity and mortality by causing serious hemodynamic alterations in the early and late postoperative period. In this review article , we aimed to review the significance and the management of low cardiac output in the light of current literature.

___

  • 1. Lomivorotov VV, Efremov SM, Kirov MY, Fominskiy EV, Karaskov AM. Low-cardiac-output syndrome after cardiac surgery. J Cardiothorac Vasc Anesth. 2017;31:291- 308. https://doi.org/10.1053/j.jvca.2016.05.029
  • 2. Pérez Vela JL1, Martín Benitez JC, Carrasco Gonzalez M, et al. Summary of the consensus document: Clinical practice guide for the management of low cardiac output syndrome in the postoperative period of heart surgery. Med Intensiva. 2012;36:277-87. https://doi.org/10.1016/j.medin.2012.01.016
  • 3. Pérez Vela JL, Jiménez Rivera JJ, Alcalá Llorente MÁ, et al. Low cardiac output syndrome in the postoperative period of cardiac surgery. Profile, differences in clinical course and prognosis. The ESBAGA study. Med Intensiva. 2018;42:159-67. https://doi.org/10.1016/j.medin.2017.05.009
  • 4. Taşkaya ME. Düşük Kalp Debisi. Turkiye Klinikleri J Cardiovasc Surg-Special Topics. 2012;4:119-25.
  • 5. Epting CL, McBride ME, Wald EL, Costello JM. Pathophysiology of post-operative low cardiac output syndrome. Curr Vasc Pharmacol. 2016;14:14-23. https://doi.org/10.2174/1570161113666151014123718
  • 6. Ding W, Ji Q, Shi Y, Ma R. Predictors of low cardiac output syndrome after isolated coronary artery bypass grafting. Int Heart J. 2015;56:144-9. https://doi.org/10.1536/ihj.14-231
  • 7. Algarni KD1, Maganti M, Yau TM. Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: trends over 20 years. Ann Thorac Surg. 2011;92:1678-84. https://doi.org/10.1016/j.athoracsur.2011.06.017
  • 8. Maganti M, Badiwala M, Sheikh A, Scully H, Feindel C, David TE, Rao V. Predictors of low cardiac output syndrome after isolated mitral valve surgery. J Thorac Cardiovasc Surg. 2010;140:790-6. https://doi.org/10.1016/j.jtcvs.2009.11.022
  • 9. Balderas-Muñoz K1, Rodríguez-Zanella H2,3, FritcheSalazar JF, et al. Improving risk assessment for postsurgical low cardiac output syndrome in patients without severely reduced ejection fraction undergoing open aortic valve replacement. The role of global longitudinal strain and right ventricular free wall strain. Int J Cardiovasc Imaging. 2017;33:1483-9. https://doi.org/10.1007/s10554-017-1139-6
  • 10. Tolpin DA, Collard CD, LeeV-V, et al. Obesity is associated with increased morbidity after coronary artery bypass graft surgery in patients with renal insufficiency. J Thorac Cardiovasc Surg. 2009;138:873-9. https://doi.org/10.1016/j.jtcvs.2009.02.019
  • 11. Leontyev S, Davierwala PM, Gaube LM, et al. Outcomes of dialysis-dependent patients after cardiac operations in a single-center experience of 483 patients. Ann Thorac Surg. 2017;103:1270-76. https://doi.org/10.1016/j.athoracsur.2016.07.052
  • 12. Lomivorotov VV, Efremov SM, Boboshko VA, et al. Evaluation of nutritional screening tools for patients scheduled for cardiac surgery. Nutrition. 2013;29:436- 42. https://doi.org/10.1016/j.nut.2012.08.006
  • 13. Allen M. Lactate and acid base as a hemodynamic monitor and markers of cellular perfusion. Pediatr Crit Care Med. 2011;12:43-9. https://doi.org/10.1097/PCC.0b013e3182211aed
  • 14. Kır B, Bilgili B, Cinel İ. Miks venöz oksijen satürasyonu ve klinik önemi. Anestezi Dergisi. 2014;22:181-5.
  • 15. Williams J, McLean A, Ahari J, et al. Decreases in mixed venous blood O2 saturation in cardiac surgery patients following extubation. J Intensive Care Med. 2017;1:885066617741435. https://doi.org/10.1177/0885066617741435
  • 16. Rhodes LA, Erwin WC, Borasino S, Cleveland DC, Alten JA. Central venous to arterial CO2 difference after cardiac surgery in infants and neonates. Pediatr Crit Care Med. 2017;18:228-33. https://doi.org/10.1097/PCC.0000000000001085
  • 17. Cuschieri J, Rivers EP, Donnino MW, et al. Central venous-arterial carbon dioxide difference as an indicator of cardiac index. Intensive Care Med. 2005;31:818- 22. https://doi.org/10.1007/s00134-005-2602-8
  • 18. Pan C, Zhang H, Liu J. Values of mixed venous oxygen saturation and difference of mixed venous-arterial partial pressure of carbon dioxide in monitoring of oxygen metabolism and treatment after open-heart operation. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014;26:701-5. https://doi.org/10.3760/cma.j.issn.2095-4352.2014.10.004
  • 19. Muehlschlegel JD, Perry TE, Liu KY, et al. Heart-type fatty acid binding protein is an independent predictor of death and ventricular dysfunction after coronary artery bypass graft surgery. Anesth Analg. 2010;111:1101-9. https://doi.org/10.1213/ANE.0b013e3181dd9516
  • 20. Holm J, Szabó Z, Alehagen U, Lindahl TL, Cederholm I. Copeptin release in cardiac surgery-a new biomarker to identify risk patients? J Cardiothorac Vasc Anesth. 2018;32:245-50. https://doi.org/10.1053/j.jvca.2017.06.011
  • 21. Pérez-Navero JL, de la Torre-Aguilar MJ, Ibarra de la Rosa I, et al. Cardiac biomarkers of low cardiac output syndrome in the postoperative period after congenital heart disease surgery in children. Rev Esp Cardiol (Engl Ed). 2017;70:267-74. https://doi.org/10.1016/j.rec.2016.09.011
  • 22. Hernández-Leiva E, Dennis R, Isaza D, Umaña JP. Hemoglobin and B-type natriuretic peptide preoperative values but not inflammatory markers, are associated with postoperative morbidity in cardiac surgery: a prospective cohort analytic study. J Cardiothorac Surg. 2013;8:170. https://doi.org/10.1186/1749-8090-8-170
  • 23. Lomivorotov VV, Efremov SM, Boboshko VA, et al. Preoperative total lymphocyte count in peripheral blood as a predictor of poor outcome in adult cardiac surgery. J Cardiothorac Vasc Anesth. 2011;25:975-80. https://doi.org/10.1053/j.jvca.2010.12.006
  • 24. Alkanat M, Baytan ŞH. Kalp debisi ölçüm yöntemleri. C.Ü. Tıp Fakültesi Dergisi. 2008;30:89-100.
  • 25. Chiang Y, Hosseinian L, Rhee A, Itagaki S, Cavallaro P, Chikwe J. Questionable benefit of the pulmonary artery catheter after cardiac surgery in high-risk patients. J Cardiothorac Vasc Anesth. 2015;29:76-81. https://doi.org/10.1053/j.jvca.2014.07.017
  • 26. Schmid B, Fink K, Olschewski M, et al. Accuracy and precision of transcardiopulmonary thermodilution in patients with cardiogenic shock. J Clin Monit Comput. 2016;30:849-56. https://doi.org/10.1007/s10877-015-9782-8
  • 27. Auxiliadora Martins M, Coletto FA, Campos AD, BasileFilho A. Indirect calorimetry can be used to measure cardiac output in septic patients? Acta Cir Bras. 2008;23 Suppl 1:118-25; discussion 125. https://doi.org/10.1590/S0102-86502008000700020
  • 28. Sponholz C, Schelenz C, Reinhart K, Schirmer U, Stehr SN. Catecholamine and volume therapy for cardiac surgery in Germany--results from a postal survey. PLoS One. 2014;9:e103996. https://doi.org/10.1371/journal.pone.0103996
  • 29. Minokadeh A, Pinsky MR. Postoperative hemodynamic instability and monitoring. Curr Opin Crit Care. 2016;22:393-400. https://doi.org/10.1097/MCC.0000000000000320
  • 30. Hickok RL, Spaeder MC, Berger JT, Schuette JJ, Klugman D. Postoperative abdominal NIRS values predict low cardiac output syndrome in neonates. World J Pediatr Congenit Heart Surg. 2016;7:180-4. https://doi.org/10.1177/2150135115618939
  • 31. Butler E, Nguyen J, Mahendran S, Aneman A. Fluid responsiveness after cardiac surgery (FRACAS): A prospective observational study using peripheral nearinfrared spectroscopy. J Cardiothorac Vasc Anesth. 2018;32:197-204. https://doi.org/10.1053/j.jvca.2017.03.019
  • 32. Protsyk V, Rasmussen BS, Guarracino F, Erb J, Turton E, Ender J. Fluid management in cardiac surgery: Results of a survey in european cardiac anesthesia departments. J Cardiothorac Vasc Anesth. 2017;31:1624-9. https://doi.org/10.1053/j.jvca.2017.04.017
  • 33. Nielsen DV, Torp-Pedersen C, Skals RK, Gerds TA, Karaliunaite Z, Jakobsen CJ. Intraoperative milrinone versus dobutamine in cardiac surgery patients: a retrospective cohort study on mortality. Crit Care. 2018;22:51. https://doi.org/10.1186/s13054-018-1969-1
  • 34. Schumann J, Henrich EC, Strobl H, et al. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. 2018;1:CD009669. https://doi.org/10.1002/14651858.CD009669.pub3
  • 35. Cholley B, Caruba T, Grosjean S, et al. Effect of levosimendan on low cardiac output syndrome in patients with low ejection fraction undergoing coronary artery bypass grafting with cardiopulmonary bypass: The LICORN randomized clinical trial. JAMA. 2017;318:548- 56. https://doi.org/10.1001/jama.2017.9973
  • 36. Sanfilippo F, Knight JB, Scolletta S, et al. Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery: a systematic review and meta-analysis. Crit Care. 2017;21:252. https://doi.org/10.1186/s13054-017-1849-0
  • 37. Desai AS, Jarcho JA. Levosimendan for the low cardiac output syndrome after cardiac surgery. N Engl J Med. 2017;376:2076-8. https://doi.org/10.1056/NEJMe1705455
  • 38. Koprivanac M, Kelava M, Soltesz E, et al. Advances in temporary mechanical support for treatment of cardiogenic shock. Expert Rev Med Devices. 2015;12:689- 702. https://doi.org/10.1586/17434440.2015.1086265
  • 39. Parissis H, Leotsinidis M, Akbar MT, Apostolakis E, Dougenis D. The need for intra aortic balloon pump support following open heart surgery: Risk analysis and outcome. J Cardiothorac Surg. 2010;5:20. https://doi.org/10.1186/1749-8090-5-20
  • 40. Vanden Eynden F, Mets G, De Somer F, Bouchez S, Bove T. Is there a place for intra-aortic balloon counterpulsation support in acute right ventricular failure by pressure-overload? Int J Cardiol. 2015;197:227-34. https://doi.org/10.1016/j.ijcard.2015.06.092
  • 41. Rastan AJ, Dege A, Mohr M, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139:302-11, 311.e1. https://doi.org/10.1016/j.jtcvs.2009.10.043
  • 42. Shishehbor MH, Moazami N, Tong MZ, Unai S, Tang WH, Soltesz EG. Cardiogenic shock: From ECMO to Impella and beyond. Cleve Clin J Med. 2017;84:287- 95. https://doi.org/10.3949/ccjm.84gr.17002
  • 43. Borisenko O, Wylie G, Payne J, et al. Thoratec CentriMag for temporary treatment of refractory cardiogenic shock or severe cardiopulmonary insufficiency: a systematic literature review and meta-analysis of observational studies. ASAIO J. 2014;60:487-97. https://doi.org/10.1097/MAT.0000000000000117
  • 44. Ranucci M, Castelvecchio S, Biondi A, et al. Surgical and Clinical Outcome Research (SCORE) Group. A randomized controlled trial of preoperative intra-aortic balloon pump in coronary patients with poor left ventricular function undergoing coronary artery bypass surgery. Crit Care Med. 2013;41:2476-83. https://doi.org/10.1097/CCM.0b013e3182978dfc
  • 45. Pilarczyk K, Boening A, Jakob H, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg. 2016;49:5-17. https://doi.org/10.1093/ejcts/ezv258
  • 46. Zeng J, He W, Qu Z, Tang Y, Zhou Q, Zhang B. Cold blood versus crystalloid cardioplegia for myocardial protection in adult cardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth. 2014;28:674-81. https://doi.org/10.1053/j.jvca.2013.06.005
  • 47. Landoni G, Biondi-Zoccai GG, Zangrillo A, et al. Desflurane and sevoflurane in cardiac surgery: a metaanalysis of randomized clinical trials. J Cardiothorac Vasc Anesth. 2007;21:502-11. https://doi.org/10.1053/j.jvca.2007.02.013
  • 48. Cerillo AG, Storti S, Kallushi E, et al. The low triiodothyronine syndrome: a strong predictor of low cardiac output and death in patients undergoing coronary artery bypass grafting. Ann Thorac Surg. 2014;97:2089- 95. https://doi.org/10.1016/j.athoracsur.2014.01.049
  • 49. Osawa EA, Rhodes A, Landoni G, et al. Effect of perioperative goal-directed hemodynamic resuscitation therapy on outcomes following cardiac surgery: A randomized clinical trial and systematic review. Crit Care Med. 2016;44:724-33. https://doi.org/10.1097/CCM.0000000000001479
Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal
Sayıdaki Diğer Makaleler

Efficacy of Pleth Variability Index (PVI) to Evaluate Intraoperative Fluid Management During Orthopedic Spinal Surgery: A Randomized Controlled Trial

Eralp ÇEVİKKALP, İsmet TOPÇU, Arzu AÇIKEL, Semih SARILAR, Gönül TEZCAN KELEŞ, Beyhan Cengiz ÖZYURT

Assessment of Patients Discharged From the Intensive Care Unit with Tracheostomy: A Retrospective Analysis of Single-Center Data

Gamze KÜÇÜKOSMAN, Duygu KOCAKULAK, Hilal AYOĞLU

Palyatif Bakım ve Yoğun Bakım Ünitelerinde Basınç Ülserine Yapılan Geleneksel Pansuman ve Topikal L-Prolin Uygulanmasının Karşılaştırılması

Yeliz ŞAHİNER, Murat KENDİRCİ

Preterm Eylem ile Sezaryene Alınan Akut Eroin Kullanımı Olan Hastada Anestezi Yönetimi

Harun ÖZMEN, Bahar AYDINLI, Uğur Serkan ÇİTİLCİOĞLU, Aydın YÜCEL

Distrofik Epidermolisis Bullosalı Hastaya Anestezik Yaklaşım: Olgu Sunumu

Mürüvvet DAYIOĞLU, Nermin KILIÇARSLAN, Selim Can YIRTIMCI

Açık Kalp Cerrahisi Sonrası Gelişen Düşük Kalp Debisi

Nesrin BOZDOĞAN ÖZYILKAN

Ultrasonography for Pediatric Central Vein Catheterisation in Inexperienced Hands: A Preliminary Report

Çiğdem YILDIRIM GÜÇLÜ, Gülnur GÖLLÜ, Başak Ceyda MEÇO, Gönül KÜÇÜK, Zekeriya ALANOĞLU, Hüseyin DİNDAR, NESLİHAN ALKIŞ

Effectiveness of Dexmedetomidine for Controlled Hypotension in Providing Optimum Surgical Conditions for Functional Endoscopic Sinus Surgeries: A Double-Blinded Randomized Controlled Trial

Soma Ganesh Raja NEETHİRAJAN, Nivash CHANDRASEKARAN, Aruna PARAMESWARİ

Postoperative Neurologic Deficit After Central Neuraxial Anesthesia in a Patient with Preoperative Non-Specific Back Pain

Bahattin TUNCALI, Hakan BOYA, Şükrü ARAÇ

Trakeostomili Olarak Yoğun Bakım Ünitesinden Taburcu Edilen Hastaların Değerlendirilmesi: Tek Merkez Verilerinin Retrospektif Analizi

Hilal AYOĞLU, Gamze KÜÇÜKOSMAN, Duygu KOCAKULAK