Arteryel switch operasyonları sonrası gecikmiş sternal kapanma: tek merkez deneyimi

Amaç: Arteryel switch ameliyatından sonra gecikmiş sternal kapanma hemoraji, tamponad ve ödem tedavisinde terapötik bir seçenektir. Bu çalışmanın amacı, arteryel switch operasyonu sonrası gecikmiş sternal kapanma ile mediastinit ilişkisini değerlendirmektir.Gereç ve Yöntem: Ocak 2011 ile Kasım 2016 arasında, Büyük arter transpozisyonu veya Taussig-Bing anomalisi nedeniyle Arteryel switch ameliyatı yapılan ve gecikmiş sternal kapatma uygulanan ardışık 43 hasta retrospektif olarak incelendi. Hastaların aynı cerrah tarafından uygulandı. Gecikmiş sternal kapanma endikasyonu, sternal kapatılma zamanı, kardiyopulmoner bypass öncesi ve sonrası ve metabolik durum, mortalite, enfeksiyon parametreleri kaydedildi.Bulgular: Ortalama sternal kapanma süresi 2.7 gün idi. Ölüm oranı 2.32% (n=1) idi. Postoperatif enfeksiyon nedeniyle 5 (11.63%) hastada antibiyotik kullanımı uzun sürdü. Gram negatif mikroorganizma baskınlığı vardı. Postoperatif mediastinitli hasta yoktu. Ameliyat sonrası enfeksiyon hızı istatistiksel olarak kardiyopulmoner baypas zamanı, sternal kapatma zamanı ve yoğun bakım ünitesinde kalış süresi ile birlikte artmadı. Öte yandan, mortalite sadece bir hastada görülmüştür. Bu hastaların tanıları bing anomalisini tek koroner ostia ile, postoperatif dönemde ise yoğun bakım ünitesinde ekstrakorporeal membran oksijenasyonuna ihtiyaç duydu.Sonuç: Arterial anahtar işlemlerinden sonra gecikmiş sternal kapatmanın kullanılması önemli bir yönetim stratejisidir. Çalışmamızda, sternum kapanma süresinin uzaması postoperatif enfeksiyon ve mediastinit oranı ile ilişkili bulunmamıştır.

Anahtar Kelimeler:

Gecikmiş sternal kapatma, arteriel switch ameliyatı, mediastinit

Delayed sternal closure after arterial switch operations: a single center experience

Purpose: Delayed sternal closure after arterial switch operation is a therapeutic option in the treatment of the hemorrhage, tamponade and edema. The purpose of this study is to evaluate the relationship between delayed sternal closure and mediastinitis after arterial switch operation.Material and Methods: Between January 2011 and November 2016, 43 consecutive patients undergoing arterial switch surgery and delayed sternal closure due to major arterial transposition or Taussig-Bing anomaly were examined retrospectively. The patients' operations were performed by the same surgeon. Indications for delayed sternal closure, sternal closure time, pre- and post-cardiopulmonary bypass, and metabolic status, mortality, and infection parameters were recorded.Results: The mean sternal closure time was 2.7 days. The mortality rate was 2.32 % (n=1). 5 (11.63%) patients required prolonged antibiotic use due to postoperative infection. There was gram negative microorganism predominance. There were no patients with postoperative mediastinitis. Postoperative infection rate statistically not increased with cardiopulmonary bypass time, sternal closure time and intensive care unit stay time. On the other hand, the mortality was seen only one patient. This patients’ diagnosis was taussing bing anomaly with single coronary ostia and postoperatively patient needed extracorporeal membrane oxygenation in Intensive care unit. Conclusions: Use of delayed sternal closure is an important management strategy after arterial switch operations. In our study, the prolonged sternal closure time is not associated with increased rate of postoperative mediastinit.

Keywords:

Delayed sternal closure, arterial switch operation, mediastinitis,

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