Konjenital Kalp cerrahisinde Uzaktan İskemik Önkoşullama İle Miyokardiyal Koruma: Bekleneni Sağlıyor Mu?

Amaç: Antioksidan ajanların organ fonksiyonları üzerindeki koruyucu etkilerinin keşfedilmesi, bu sistemin yapay olarak test edilmesine olanak sağlamıştır. Konjenital kalp defekti olan hastalarda uzaktan iskemik önkoşullamanın cerrahi klinik sonuçlar üzerindeki etkisi belirsizdir. Bu çalışma iskemik önkoşullamanın kardiyak koruma üzerindeki erken sonuçlarını araştırdı. Yöntemler: Tek merkezde kompleks konjenital kalp cerrahisi uygulanan tüm hastaların prospektif incelemesi yapıldı. Rastgele gruplandırılmış hastalardan alınan kan örneklerinde antioksidan enzimatik analiz yapıldı. Bulgular: Hastaların ortanca cerrahi yaşı iskemik önkoşullama grubunda (grup 1) 19,1 ay (3,7-57,7), kontrol grubunda (grup 2) 16,7 ay (7,8-35,9) idi. Hastaların ortanca takip süresi grup 1'de 58,3 ay (54,3-62,1), grup 2'de 37,1 ay (34,8-41,7) idi. Erken mortalite 4 (%4,4) hastada görüldü. Geç mortalite görülmedi. Süperoksit Dismutaz, Malondialdehit ve kardiyak belirteçlerin düzeyleri açısından gruplar arasında anlamlı fark vardı (p<005). Sonuç: İskemik önkoşullamanın kardiyak korumaya etkisi henüz kanıtlanmamıştır. Özellikle doğuştan kalp hastalarında hipoksi, siyanoz gibi kronik uyaranlar ya da ameliyat öncesinde kullanılan ilaçlar çalışmanın sonuçlarını etkileyebilmektedir. Bu hastalarda mortalite açısından anlamlı bir fark olmasa da hastanede kalış süresine olumlu etki umut vericidir.

Anahtar Kelimeler:

İskemik Önkoşullama, Konjenital Kalp Defekti, Miyokardiyal Koruma

Myocardial Protection With Remote Ischemic Preconditioning In Congenital Heart Surgery: Does It Deliver What Is Expected?

Objective: The discovery of the protective effects of antioxidant agents on organ functions enabled this system to be tested artificially. The impact of remote ischemic preconditioning (RIPC) on surgical clinical outcomes in patients with congenital heart defects is unclear. This study investigated the early consequences of ischemic preconditioning on cardiac protection. Methods: The study was designed prospectively. Cuffs were applied to one leg of patients in Group 1 (RIPC) after induction of anesthesia in three cycles (5 min inflation followed by 5 min reperfusion) to precondition ischemia-reperfusion. Antioxidant and cardiac marker levels were recorded in blood samples. Results: The patients' surgical median age was 19.1 months (IQR= 3.7- 57.7 months) in Group 1 (RIPC) and 16.7 months (IQR= 7.8- 35.9 months) in Group 2 (Control). The patients' median follow-up period was 58.3 months (IQR= 54.3- 62.1 months) in group 1 and 37.1 months (IQR= 34.8- 41.7 months) in group 2. Hospital mortality was in 7 (10.4%) patients. There was no late mortality. There was a significant difference between the groups in terms of Superoxide Dismutase (SOD) and Malondialdehyde (MDA) levels (p<005). Conclusion: The effects of ischemic preconditioning on cardiac protection have not been proven yet. Especially in congenital cardiac patients, chronic stimuli such as hypoxia and cyanosis or drugs used before surgery may affect the study’s results. Although there is no significant difference in mortality in these patients, a positive effect on the length of hospital stay is promising.

Keywords:

Congenital Heart Defect, Ischemic Preconditioning, Myocardial Protection,

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