Orkut GÜÇLÜ, Süleyman YAZICI, Suat CANBAZ, Binali MAVİTAŞ, Ahmet ÇALIŞKAN, Turan EGE, Celal YAVUZ, Sinan DEMİRTAŞ

Diyalize bağımlı kronik böbrek yetmezliği olan hastalarda açık kalp cerrahisi

Amaç: Kronik böbrek yetmezliği (KBY) olan hastalar çeşitli nedenlerle açık kalp cerrahisi için önemli bir risk grubunu oluşturmaktadırlar. Bu hastalarda kardiyak hastalıklar, normal popülasyona göre daha yüksek oranda görülür. Yapılan birçok çalışmaya göre kronik diyaliz bağımlılığı halen tek başına mortalite ve morbidite üzerine etkili bir risk faktörüdür. Bu çalışmada, kalp cerrahisi uygulanan KBY'li hastaların sonuçları retrospektif olarak değerlendirildi.Yöntem: Kardiyopulmoner bypass (KPB) altında kardiyak cerrahi uygulanmış olan hemodiyalize bağımlı son dönem böbrek yetmezlikli 36 hasta çalışmaya dahil edildi. Bu hastaların peroperatif bulguları hasta dosyalarından geriye dönük olarak incelendi.Bulgular: Hastaların 27'si (%75) erkek, dokuzu (%25) kadın, yaş ortalaması 58,3±8,5 yıl idi. Hastalardan 12'sine koroner bypass, 10'una koroner bypass ile beraber kapak replasmanı, beş hastaya izole kapak replasmanı, üç hastaya koroner bypass ile birlikte sol ventrikülotomi, dört hastaya tek kapak replasmanı ile birlikte bir veya iki kapak tamiri, iki hastaya asendan aorta replasmanı uygulandı. Ameliyatlarda ortalama kros klemp süresi 78,1±31,3 dakika, toplam perfüzyon süresi ise 158,8±92,2 dakika idi. Hastaların yoğun bakımda kalma süresi ortalama 60±41 saat, toplam hastanede yatış süresi 12±5 gün bulundu. Postoperatif mortalite %38,8 (n=14) idi.Sonuç: Kardiyak ve renal fonksiyonlar birbiriyle yakın ilişkilidir. Son dönem böbrek yetmezliği olan hastalara kabul edilebilir riskler altında kalp cerrahisi operasyonları uygulanabilmektedir. Uygun preoperatif hazırlık, iyi hasta takibi ile morbidite ve mortalite oranlarının kabul edilebilir düzeylerde olması mümkündür

Open heart surgery in dialysis-dependent patients with end stage renal failure

Objective: Patients with chronic renal insufficiency remain a risky subgroup in open heart surgery because of various reasons. The incidence of cardiovascular disease in hemodialysis dependent renal failure is found to be higher when compared with the normal population. Chronic dialysis is still a very important independent risk factor for mortality and morbidity despite of many studies. In this study, we retrospectively evaluated the outcome of patients with chronic renal failure who had undergone to open cardiac surgery.Methods: The medical charts of 36 patients on maintenance dialysis who underwent cardiovascular surgery were retrospectively analyzed. Peroperative findings of these patients were analyzed from patients' hospital records.Results: Twenty-seven men (75%) and nine women (25%) totally 36 patients were included to study. The mean age was 58.3±8.5 years. 12 patients underwent coronary artery bypass surgery, 10 had concomitant coronary artery bypass surgery and valve replacements, five had valve replacements, three had concomitant coronary artery bypass surgery and left ventriculectomy, four had valve replacement with other valve repair, two had aortic surgery due to ascending aortic aneurysms. The mean cross clamp time was 78.1±31.3 min and the mean perfusion time was 158.8±92.2 min. The mean intensive care unit stay was 60±41 hours, and the mean hospital stay was 12±5 days. Hospital mortality rate was %38.8.Conclusions: Cardiac and renal functions are closely associated with each other. Cardiac surgery operations can be applied to patients with end-stage renal failure under acceptable risks. Appropriate preoperative preparation with good postoperative patient follow-up is necessary to have acceptable levels of morbidity and mortality rates. J Clin Exp Invest 2013; 4 (3): 335-338

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