Ahmet BOLUKÇU, Ahmet Can TOPÇU, Buğra HARMANDAR

Ekstrakardiyak Fontan Ameliyatı Sonrası Plevral Efüzyon Oluşumunu Etkileyen Risk Faktörleri

Giriş: Fontan ameliyatı tek ventrikül fizyolojisi için en sık yapılan ameliyatlardan biridir. Ameliyat sonrasında hastalar, uzamış plevral efüzyon ve başka komplikasyonlar açısından risk altındadır. Bu çalışmada; pulmoner arter basıncının, fenestrasyon yapılıp yapılmamasının, kullanılan ekstrakardiyak greftin çapının ve tromboproflaksi rejimlerinin Fontan ameliyatı sonrası uzamış plevral efüzyon gelişimine olan etkilerini araştırmayı amaçladık. Metod: Hastane veritabanında Fontan ameliyatı yapılan hastalar araştırıldı. Plevral efüzyon oluşumuna etki edebilecek potansiyel faktörler için lojistik regresyon modeli oluşturuldu. Bulgular: Toplam 67 hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 63 ay, ortalama kilosu 18 kg'dı. Plevral efüzyon 34 (%51) hastada gelişti. Tromboprofillaksi rejimi açısından değerlendirildiğinde warfarin kullanan 28 (%42) hastanın 19'unda (%68), aspirin kullanan 39 (%58) hastanın ise 15'inde (%38) plevral efüzyon görüldü. Fenestrasyon yapılmayan grupta (43 hastanın 26'sı %60) yapılanlara göre (24 hastanın 8'i %33) plevral efüzyon sıklığı anlamlı olarak daha yüksekti (p=0,03). Lojistik regresyon analizinde, fenestrasyon yapılanlarda daha az (OR, 0,3; 95% CI, 0,1-0,96; p=0,04), buna karşın warfarin kullananlarda ise daha sık (OR, 3,4; 95% CI, 1,1-9,8; p=0,02) plevral efüzyon riski olduğu görüldü. Ameliyat sonrası pulmoner arter basıncı 13 mmHg'ın üzerinde olanlarda plevral efüzyon sıklığı anlamlı olarak daha fazlaydı (p=0,002). Sonuç: Plevral efüzyon oluşumunun, ameliyat sonrasında pulmoner arter basıncının yüksek olması, warfarin kullanılması ve fenestrasyon yapılmaması ile arttığı görüldü. Greft size indeksi göreceli olarak büyük olanlarda pulmoner arter basıncı daha düşüktü; ancak bu durum plevral efüzyon oluşumuna etki etmedi.

Anahtar Kelimeler:

ekstrakardiyak greft, fontan, plevral efüzyon, fenestrasyon, warfarin

Risk factors for pleural effusion after extracardiac Fontan procedure assessment of the commonest Fontan complication

Objective: Fontan procedure is one of the most performed procedures for single ventricle physiology. After the procedure, patients are at risk for prolonged pleural effusion and other complications. We aimed to investigate the prolonged pleural effusion after Fontan procedure in terms of pulmonary arterial pressure, fenestration, diameter of the extracardiac graft, and thromboprophylaxis regimen. Methods: Hospital database was searched for the patients who underwent a Fontan operation. A logistic regression analysis model was constructed for pleural effusion. Results: A total of 67 patients were enrolled in the study. Median age was 63 months, median weight was 18 kg. Pleural effusion occurred in 34 (51%) patients. In terms of thromboprophylaxis regimens, 28 (42%) patients were on warfarin, of those 19 (68%) had pleural effusion. Of 39 (58%) patients who were in aspirin group, 15 had (38%) pleural effusion (p=0.018). Pleural effusion was more frequent in the non-fenestration group (26 of 43, 60% vs. 8 of 24, 33%), significantly (p=0.03). Logistic regression analyses revealed that fenestrated group was less likely to (OR, 0.3; 95% CI, 0.1-0.96; p=0.04) and warfarin group was prone to (OR, 3.4; 95% CI, 1.1-9.8; p=0.02) have pleural effusion. In individuals who had a pulmonary artery pressure higher than 13 mmHg postoperatively, pleural effusion was more frequent (p=0.002). Conclusion: Pleural effusion occurrence increased with higher postoperative pulmonary artery pressure, warfarin use, and absence of fenestration. Patients with relatively higher graft size index had a lower pulmonary artery pressure, although this is not reflected in pleural effusion occurrence.

Keywords:

fontan, extracardiac graft, pleural effusion, fenestration, warfarin,

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