Ventriküler destek cihazı takılan son dönem kalp yetmezliği hastalarında obezite ile artmış postoperatif komplikasyon gelişim riskinin ilişkisi

Amaç: Ventriküler destek cihazı (VDC) uygulanan son dönem kalp yetmezliği (SDKY) olgularında obezite ile postoperatif komplikasyon sıklığı ilişkisinin incelenmesi. Gereç ve Yöntem: Kliniğimizde SDKY tanısı ile devamlı akım sağlayan VDC implantasyonu uygulanan 373 hastanın kayıtları retrospektif olarak taranmıştır. Çalışmaya taranan komplikasyonlara yatkınlık yaratacak kontrolsüz metabolik hastalığı bulunmayan ve en az üç ay süreli takibi olan 167 olgu dahil edilmiştir. Demografik özelliklerin yanında uygulanan VDC tipi, son kontroldeki vücut kitle indeksi (VKİ), vücut yüzey alanı (VYA) değerleri ile postoperatif major komplikasyonlardan yara yeri enfeksiyonu, pompa trombozu, gastrointestinal sistem (GİS) kanaması ve serebrovasküler olay (SVO) gelişimleri her olgu için kayıtlanmıştır. Hastaların VKİ ve VYA değerleri ile taranan komplikasyonların görülme sıklıkları istatistiksel olarak karşılaştırılmıştır. Bulgular: Yirmisi (%12) kadın, toplam 167 olgunun yaş ortalaması 53.3±13.1 (12–74) yıldı. Olguların 91’inde (%54.5) dilate, geri kalanlarda ise iskemik kardiyomiyopati tanısı mevcut olup, 117’sinde (%70.1) HeartWare, 24’ünde (%14.4) HeartMate-2 ve 26’sında (%15.6) HeartMate-3 cihazı implante edilmiştir. Postoperatif ortalama 26.1±18.2 aydaki son kontrolde ölçülen VKİ ve VYA ortalaması 27.7±4.3 ve 1.97±0.20 m2 idi. Tüm grupta yara yeri enfeksiyonu, pompa trombozu, GİS kanaması ve SVO sıklıkları sırasıyla %22.8, %21.0, %15.0 ve %15.6 olarak bulundu. Daha yüksek VKİ’li olgularda pompa trombozu ve GİS kanaması görülme sıklığının arttığı (p=0.047 ve p=0.018), daha yüksek VYA olgularında da GİS kanaması görülme riskinin yükseldiği saptandı (p=0.016). Ayrıca obezlerde GİS kanaması ve SVO riskinin yüksek olduğu bulundu (p=0.012 ve p=0.040). Sonuç: Kalp naklinde mortalite için ciddi risk faktörü olduğu bilinen obezite, transplantasyona köprüleme amaçlı VDC implantasyonu kararında da hasta seçiminde dikkat edilmesi gereken bir durumdur.

Correlation between obesity and increased postoperative complication risk in endstage heart failure patients who underwent ventricular assist device implantation

Aim: Evaluation of the correlation between obesity and postoperative complication risk in end-stage heart failure (ESHF) patients who underwent ventricular assist device (VAD) implantation. Materials and Methods: The charts of 373 ESHF patients underwent continuous-flow VAD implantation were reviewed retrospectively. One hundred-sixty-seven cases with minimum three months of postoperative follow-up were enrolled. Demographics and implanted VAD type, body mass index (BMI) and body surface area (BSA) that measured at the last follow-up visit as well as the presence of major postoperative complications including wound infection (WI), pump thrombosis (PT), gastrointestinal bleeding (GIB), and cerebrovascular event (CVE) were noted for each participant. Prevalence of the evaluated complications were statistically compared with both BMI and BSA scores. Results: Of the 167 cases with a mean age of 53.3±13.1 (12-74) years, 20 (12%) were females. Implanted VAD type was HeartWare in 117 cases (70.1%), HeartMate-2 in 24 cases (14.4%), and HeartMate-3 in 26 cases (15.6%). Mean follow-up, BMI and BSA scores were 26.1±18.2 months, 27.7±4.3 and 1.97±0.20 m2 , respectively. Prevalence of WI, PT, GIB, and CVE were 22.8%, 21.0%, 15.0%, and 15.6%, respectively. Increased PT and GIB risks were found in cases with higher BMI (p=0.047 and p=0.018, respectively); and GIB risk was higher in subjects with greater BSA (p=0.016). Obese patients had also higher risk for the development of both GIB and CVE (p=0.012 and p=0.040, respectively). Conclusion: Obesity; which is a well-known risk factor for mortality in heart transplantation, may also be a predictive factor in deciding the optimal candidates for VAD implantation.

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