Kardiyak reoperasyonlar erken dönem mortaliteyi artırır mı?

Giriş: Kardiyak reoperasyonlar invazif kardiyolojinin gelişmesi, hasta yaşlarının ve yaşam beklentilerinin artması nedeniyle giderek kalp cerrahisinde daha sık yapılan ameliyatlar olmaktadır. Yaşam süre ve kalitesi uzayan hastalar ateroskleroz sürekli bir proses olduğundan bir süre sonra greft yetmezliği ya da greft stenozu gibi nedenlerden yeniden semptomatik hale gelmekte ve reoperasyon için refere edilmektedir. Prostetik kalp kapakçıklarının bozukluklarında, önemli paravalvüler kaçak varlığında ve dejenere olmuş biyoprotezlerin varlığında kalp kapakçıklarının yeniden değiştirilmesi gerekmektedir. Böyle hastaların sayılarının artış göstermesi reoperasyonların sonuçlarının değerlendirilmesini gerekli kılmıştır. Bu çalışmada kliniğimizde yapılan kardiyak reoperasyonlar erken dönem sonuçlarının ışığında morbidite, mortalite ve komplikasyon oranları ve nedenleri açısından incelenmiş ve kardiyak reoperasyonların tek başlarına bir mortalite nedeni olup olmadıkları araştırılmıştır. Materyal ve Metod: Ocak 2007-Mayıs 2010 tarihleri arasında 47 kardiyak reoperasyon gerçekleştirilmiştir. Hastaların demografik, operatif ve postoperatif bilgileri hastaların bilgi işlem kayıtları ve dosyalarındaki ameliyat raporları ve kontrol formları değerlendirilmeye alınarak retrospektif olarak incelenmiştir. Bulgular: Çalışmamıza katılan hasta grubunda yalnızca iki erken dönem mortalite oluşmuştur (%4.3). Bir hastada renal, pulmoner ve nörolojik komplikasyon görülmüş olup, bu hasta kaybettiğimiz hastalardan biridir. İki hastada gastrointestinal kanama görülmüş olup, bunlardan biri kaybedilen hastamızdır. Toplam komplikasyon oranı %4.3 olarak gerçekleşmiştir. Sonuç: Kardiyak reoperasyonlar endikasyon konulduğunda düşük mortalite ve düşük komplikasyon riski ile gerçekleştirilebilmektedir. Mortalitelere komorbiditeler neden olmaktadır. Daha önceden reoperasyon yapılması başlı başına bir risk faktörü kabul edilirdi. Son dönemde kardiyak reoperasyon ameliyatlarının kendisi artık mortalite nedeni olmaktan çıkmaya başlamıştır.

Do cardiac reoperations increase early mortality?

Introduction: Cardiac reoperations are ever increasing as invasive cardiology develops and average patient age and life expectancies increase. Patients with increased life expectancies and life qualities become symptomatic after a time due to graft insufficiencies and stenoses because atherosclerosis is inherently a continuous process. This causes an increase in referrals for reoperative procedures. Reoperations are necessary in failing prosthetic cardiac valves, in the presence of a significant paravalvular leak and for degenerated bioprostheses. It became a necessity to evaluate results of reoperations as a result of an increase in the number of such patients. In this study we evaluated the rates of morbidity, mortality and complications in our patients who underwent cardiac reoperations with respect to the results of the early period and the question whether reoperations by themselves are risk factors for morbidity and mortality or not was tried to be answered. Materials and Methods: Forty seven cardiac reoperations have been performed in our institution between January 2007 and May 2010. The patients’ demographic, operative and postoperative data were retrospectively evaluated using dossier and digitally recorded information including operation records and control forms. Results: We only observed two early mortalities (4.3%) in our study group. One patient had a combined renal, pulmonary and neurological complication that resulted in his moratlity. Two patients had gastrointestinal hemorrhage one of whom died. Total complication rate was found as 4.3%. Conclusion: Cardiac reoperations can be performed with low mortality and complication rates when indicated. Mortalities are caused by comorbidities. Until recently reoperations were accepted as a risk factor by themselves. In the current time cardiac reoperations by themselves are beginning to be no longer risk factors for mortality.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi