Mehmet ÇAKICI, Evren ÖZÇINAR, Serkan DURDU, Mustafa Bahadır İNAN, Ahmet RÜÇHAN AKAR, Mustafa ŞIRLAK, Çağdaş BARAN, Ömer Arda ÇETİNKAYA, Ali İhsan HASDE

Koroner Bypass Cerrahisi Sonrası Gelişen Akut Mezenter İskemi ve Dalak Enfarktı: 32 Hastanın Analizi

Amaç: Akut mezenter iskemi ve diğer uç organ embolileri kardiyak cerrahi sonrası hayatı tehdit eden ciddi komplikasyonlardır. Bu çalışmada, açıkkalp cerrahisi sonrası gelişen mezenter iskemi ve dalak enfarktı hastalarının sonuçlarını değerlendirdik.Gereç ve Yöntem: Kliniğimizde Ocak 2010-Kasım 2017 yılları arasında, açık kalp cerrahisi uygulanan tüm hastalar analiz edildi ve kaydedilmiş akutmezenter iskemi ve dalak enfarktı olan hastalar retrospektif olarak incelendi.Bulgular: Çalışmaya 5607 hasta dahil edildi, 32 hastada (%0,57) akut mezenterik iskemi ve splenik enfarkt gözlendi. Mezenter iskemi ön tanısıylaoperasyona alınan altı hastada dalak enfarktı tespit edildi. Bu hastalarda, splenektomi sonrası semptomlar tamamen geriledi ve bütün hastalarhayatta kaldı. Segmenter barsak rezeksiyonu sonrası yalnızca 26 hastanın ikisi sağ kaldı. Toplam mortalite 24’tü (%75). Yaş (p=0,03), diyalizgereksinimi (p=0,01), acil kardiyak operasyon (p=0,05), periferik arter hastalığı (p=0,001) ve yüksek risk Euroscore’ları (p=0,0001) kontrol grubunakıyasla anlamlı olarak farklıydı. Mezenter iskemi, çalışan kalpte yapılan koroner bypass hastalarında anlamlı olarak daha fazla gözlendi (p=0,0001).Yine mezenter iskemi gelişen gruptaki kardiyopulmoner bypass süreleri kontrol grubuna göre anlamlı olarak daha yüksekti (p=0,0001).Sonuç: Kardiyak cerrahi sonrası, akut mezenter iskemi hala oldukça yüksek mortalite oranlarına sahiptir. Splenik infark semptomları mezenteriskemiyi taklit edebilir. Yüksek riskli kardiyak operasyonlarda mezenter iskemi daha sık gözlenmektedir. Erken tanı ve tedavi hayat kurtarıcı olabilir.

Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients

Objectives: Acute mesenteric ischemia and other end organ emboli are serious life-threatening complications after open-heart surgery. In this study, we evaluated the outcome of patients with mesenteric ischemia and splenic infarction after cardiac surgery. Materials and Methods: From January 2010 to November 2017, all patients (5607) who underwent open-heart surgery were analysed, and patients with registered acute mesenteric ischemia and splenic infarct (32) were retrospectively reviewed. Results: Five thousand six hundred and seven patients were included in this study, of which 32 (0.57%) patients suffered from acute mesenteric ischemia and splenic infarct. Intraoperatively, splenic infarction was detected in six patients who were pre-diagnosed as mesenteric ischemia. In these patients, the symptoms completely improved after the splenectomy and all the patients survived. Only two of 26 patients were survived after segmentary bowel resection. Overall mortality was 24 (%75). Age (p=0.03), need for dialysis (p=0.01), emergency cardiac operation (p=0.05), peripheral arterial disease (p=0.001), and high risk Euroscore (p=0.0001) were significantly different compared to the control group. Mesenteric ischemia was significantly higher in off- pump coronary artery bypass patients (p=0.0001). The time of cardiopulmonary bypass in mesenteric ischemia group was significantly higher than the control group (p=0.0001). Conclusion: Acute mesenteric ischemia is still highly mortal, after cardiac surgery. Splenic infarct symptoms may mimic mesenteric ischemia. Mesenteric ischemia is more common in high-risk cardiac operations. Prompt diagnosis and treatment can be life-saving.

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