Celalettin GÜNAY, Kıvanç ATILGAN, Ertan DEMİRDAŞ

KORONER ARTER CERRAHİSİ SONRASI GÖRÜLEN ATRİYAL FİBRİLASYON GELİŞİMİNE ETKİ EDEN FAKTÖRLER

Amaç: İzole koroner arter baypas greftleme (KABG) sonrası atriyal fibrilasyon (AF) gelişimi stroke, ekstremite iskemisi, pulmoner emboli gibi birçok morbidite ve mortalitesi yüksek komplikasyonu beraberinde getiren, hastanede kalış süresini ve maliyeti arttıran bir komplikasyondur. KABG uygulanan hastaların %20-40'ında ve en sık 2. ve 4. günler arasında gerçekleşmektedir. Fizyopatolojinin tam olarak ortaya konulamaması, morbidite ve mortalitede etkin bir azalma sağlanamaması nedeniyle halen güncelliğini korumaktadır. Gereç ve Yöntem: Bu çalışmada 01 Ocak 2011 ile 31 Aralık 2011 tarihleri arasında izole KABG uygulanan 197 hastayı geriye dönük olarak inceledik. Postoperatif AF gelişimine etki edebileceğini düşündüğümüz parametreleri preoperatif, intraoperatif ve postoperatif olarak 3 grupta sınıflayarak elde ettiğimiz verileri istatistiksel olarak analiz ettik. Bulgular: Hasta yaşı, sol atriyum çapı, perkütan koroner girişim öyküsü, sağ koroner arter distal anastomozu bulunması, intraoperatif pozitif inotropik destek tedavisi, sol internal meme arteri grefti, drenaj miktarı ve yoğun bakım ünitesinde kalma süresi parametrelerini postoperatif AF gelişimi açısından istatistiksel olarak anlamlı bulduk. TG seviyeleri AF grubunda, sinüs ritmi grubuna oranla daha düşük düzeydeydi. Sonuç: KABG sonrası AF gelişimine etki eden çok sayıda parametre mevcuttur. Bu değerlerin doğru olarak tanımlanması ve alınacak önlemler ile postoperatif AF gelişiminin azaltılması mortalite ve morbiditenin azalmasına önemli katkılar sağlayacaktır.

Factors Effecting Postoperative Atrial Fibrillation Development Following Coronary Artery Bypass Grafting

Objectives: Postoperative atrial fibrillation following isolated coronary artery bypass grafting has major complications like stroke, pulmonary embolism, extremity ischemia leading long hospital stay and increased cost of hospitalization. Postoperative atrial fibrillation is seen 20-40% of patients undergoing isolated coronary artery bypass grafting and most frequently between the postoperative second and fourth days. It is still a current subject due to lack of understranding the physiopathologic mechanisms, inadequate decrease in the mortality and morbidity. Material and Methods: In this study, 197 patients who underwent isolated coronary artery baypass grafting between 1st January and 31st December in 2011 were analysed retrospectively. We have classified the factors, possible to effect postoperative atrial fibrillation, in three groups, as preoperative, intraoperative and postoperative factors, and analysed the data in statistics.Results: Preoperative age, left atrium diameter, history of percutaneous coronary intervention, occurrence of the distal anastomosis of right coronary artery, the use of intraoperative positive inotropic agents and left internal mammarian artery as an arterial graft, postoperative bleeding, the lenght of hospital stay were meaningful statistically. Triglyceride levels were lower in atrial fibrillation group. Conclusion:Consequently, there are many parameters effecting postoperative atrial fibrillation development. Understanding the mechanisms and having reasonable precautions will help in decreasing the morbidity and morrtality.

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