Mersin’de Tip 1 Aort Diseksiyonunda doku yapıştırıcısı kullanımının kanama üzerine etkisi: Kanama kontrolünün tarihsel kısa analizi

Amaç: Mersin Şehir Eğitim ve Araştırma Hastanesi’nde Tip 1 aort diseksiyonu nedeniyle acil operasyona alınan hastalarda doku yapıştırıcısı kullanımının kanama üzerine etkisini ortaya koymaktır. Kalp cerrahisinde kullanılan kanama durdurucu yöntemler ve ilaçların tarihsel gelişimini incelemektir. Yöntem: Mersin Şehir Eğitim ve Araştırma Hastanesi kalp ve damar cerrahisi kliniğinde 2014-2019 yılları arasında Tip 1 aort diseksiyonu nedeniyle acil operasyona alınan 40 olgu geriye dönük olarak incelendi. Çalışmaya ardışık 34 hasta dâhil edildi. Hastalar ameliyatta doku yapıştırıcısı kullanılıp kullanılmamasına göre iki gruba ayrıldı. Doku yapıştırıcısı kullanılmayanlar grup 1 (n=20), kullanılanlar grup 2 (n=14) olarak tanımlandı. Tanımlayıcı analizlerde, kategorik değişkenler frekans ve yüzdeyle, sayısal değişkenler medyan kullanılarak yapıldı. İkili grup karşılaştırmalarında kategorik değişkenler için Pearson Ki Kare testi, sayısal değişkenler için Man Whitney U testi kullanıldı. Bulgular: Grup 1’deki hastaların medyan yaşı 63 iken, grup 2’de medyan yaşı 54’tü ( p=0,03). Grup 2’deki hastalarda hipertansiyon ve postoperatif solunumsal komplikasyonlar daha fazla görüldü (p=0,03). Toplam mortalite (p=0,03) ve operasyon sırasındaki mortalite (p=0,02) grup1’de daha yüksekti. Kalp cerrahisi tarihinde kullanılan kanama önleyici ajanlar ve yöntemlerin aort diseksiyon cerrahisinde de kullanıldığı görüldü. Sonuç: Tip 1 aort diseksiyonu ameliyatlarında doku yapıştırıcısı kullanımının kanama miktarı, kanama nedeniyle reoperasyon ve kan tranfüzyon ihtiyacı üzerine etkisi yoktur.

Anahtar Kelimeler:

Tip 1 aort diseksiyonu, doku yapıştırıcısı

Effect of tissue sealants on bleeding in type 1 aortic dissections in Mersin: short-historical analysis of bleeding control

Objective: To investigate the effect of tissue sealants on bleeding in patients who have been taken to emergency operation for type 1 aortic dissection. To investigate the methods and medications that were used to control bleeding throughout the history of cardiac surgery.Methods: All patients who underwent emergency operation for Type 1 aortic dissection in Mersin City Education and Research Hospital between 2014 and 2019 were retrospectively evaluated 40 patients. 34 consecutive patients were included to the study. Patients were divided into two groups. Patients in group 1 (n=20) didn’t receive tissue sealants and patients in group 2 (n=14) received tissue sealants. In descriptive analyzes, categorical variables were made by frequency and percentage, numerical variables were median. In Binary group comparisons Pearson chi-square test was used for categorical variables and Man Whitney U test was used for numerical variables.Results: Median age for Group 1 was 63, whereas it was 54 in group 2 (p=0,03). Hypertension and post operative respiratory complications were more frequent in Group 2 (p=0,03). Overall mortality and intraoperative mortality was higher in group 1 (p=0,03) and (p=0,02) respectively. Hemorrhage control agents and techniques that were used in history of cardiac surgery were also used in aortic dissection operations.Conclusion: Usage of tissue sealants in Type 1 Aortic dissection operations is ineffective on the amount of post operative bleeding, reoperation due to bleeding and the need for blood transfusions.

Keywords:

Type 1 aortic dissections, tissue sealants,

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1. Mukherjee D, Eagle KA. Aortic dissection-an update. Curr Probl Cardiol 2005; 30: 287-325.
2. Massimo CG, et al. Extended and total aortic resection in the surgical treatment of acute type A aortic dissection: Experience with 54 patients. Ann Thorac Surg 1988; 46: 420-424.
3. Mannucci PM, Levi M. Prevention and treatment of major blood loss. N Engl J Med 2007;31;356(22):23012311.
4. Christensen MC,et al. Cost of excessive postoperative hemorrhage in cardiac surgery. J Cardiovasc Surg 2009;138:687-693.
5. Welling DR, et al. A balanced approach to tourniquet use: lessons learned and relearned. J Am Coll Surg 2006;203:106-15.
6. Tourniquet. Available at: http://en.wikipedia.org/wiki/Tourniquet. Accessed October 3, 2011.
7. Rich NM, Spencer FC. Vascular Trauma. Philadelphia: W. B. Saunders Company; 1978. p. 235.
8.CRoC (Combat-Ready Clamp). Available at: https://store.combatmedical systems.com/products/CRoC-(Combat-Ready- Clamp).aspx. Accessed November 22, 2011.
9. Esmarch F. Ueber Kunstliche Bluterlee bei Operationen. Samml Klin Vortr 1873;58:373-384.
10. Hewson W. Experimental inquiries. Part I. An inquiry into the properties of the blood, with remarks on some of its morbid appearances, in Gulliver G (ed): The Works of William Hewson, FRS. London, UK, The Sydenham Society, 1846.
11. Cannon WB. Mendenhall WL. Factors affecting the coagulation time of blood. IV. The hastening of coagulation in pain and emotional excitement Am J Physiol 1914;34:251-261.
12. Bergel S. Uber die wirkung des fibrins. Dtsch Med Wochenschr 1909;35:663–5.
13. Spotnitz WD. Fibrin sealant: past, present, and future: a brief review. World J Surg 2010;34:632–4.
14. Jackson MR. Fibrin sealants in surgical practice: An overview. Am J Surg 2001;182:1S–7S.
15. Matras H. The use of fibrin sealant in oral and maxillofacial surgery. J Oral Maxillofac Surg 1982;40:617–22.
16. Schexneider KI. Fibrin sealants in surgical or traumatic hemorrhage. Curr Opin Hematol 2004;11:323–6.
17. Coover HN, Joyner FB, Shearer NH. Chemistry and performance of cyanoacrylate adhesives. Soc Plast Eng 1959;15:413–7.
18. Hong YM, Loughlin KR. The use of hemostatic agents and sealants in urology. J Urol. 2006;176:2367–74.
19. Bard Bard Announces FDA Clearance of Avitene Ultrafoam Collagen to Stop Bleeding During Surgery. Available at: http://www.findarticles.com/p/articles/mi_m0EIN/is_2000_March_9/ai_60007565/ [last cited on 2009]
20. Tengborn L, Blombäck M, Berntorp E. Tranexamic acid-an old drug still going strong and making a revival. Thromb Res. 2015Feb;135(2):23 242.
21. McLean J. The discovery of Heparin. Circulation 1959; 19:75-8.
22. Garcia DA, et al. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians EvidenceBased Clinical Practice Guidelines. Chest 2012;141 (Suppl 2): e24S-43S.
23. Lord ST, et al. Purification and characterization of recombinant human fibrinogen. Blood Coagul Fibrinolysis 1993;4(1):55–59.
24. Mikkola H, et al. Molecuİar mechanism of a mild phenotype in coagulalion factor XIII (FXIII) deficieney: A splicing mutation permitting partial corrent splicing of FXIII A-subunit mRNA. Blood 89:1279(1997).
25. Bruce D, Nokes TJC. Prothrombin complex concentrate (Beriplex P/N) in severe bleeding: experience in a large tertiary hospital. Critical Care 2008; 12(4):1-7.
26. Kaspereit F, et al. Protrombin complex concantrate mitigates diffuse bleeding after cardiopulmonary bypass in a porcine model. BrJ Anasth 2010; 105:576-82.
27. Giangrande PL. The history of blood transfusion. Br J Haematol. 2000;110(4):758–767.
28. Blundell J.Experiments on the transfusion of blood by the syringe, Med Chir Trans, 1818, vol. 9 (pg. 6-92)
29. Griswold RA, Ortner AB. The use of autotransfusion in surgery of the serous cavities, Surg Gynecol Obstet, 1943, vol. 77 (pg. 167-77)
30. Behera C,et al. Sudden death due to aortic rupture while swimming - A case report. J Indian Acad Forensic Med 2008; 30: 79-81.
31. Hiratka LF, et al. 2010 ACCF/AHA/AATS/ACR/ASA/ SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive Summary. J Am Coll Cardiol 2010;55:e27-129.
32. Hagan PG, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;283: 897-903.
33. Anagnostopoutos CE, Prahhakar MJS, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol 1972, 30: 263.
34. Christensen MC,et al. Cost of excessive postoperative hemorrhage in cardiac surgery. J Cardiovasc Surg 2009;138:687-693. Available at: http://dx.doi.org/10.1016/j.jtcvs.2009.02.021).
35. Demirtaş M,et al. Siyanoakrilat doku yapıştırcısının kardivasküler cerrahinin güç anlarında kullanımı. Turk Kardiol Dem Ars 1998;26(6):358-361.
36.Göz M, et al. Stanford tip-A akut aort disseksiyonlarında altı olguluk deneyim Six-cases experience with Stanford type-A aortic dissection. Turkısh J Cardiovasc Surg 2009;17(4):238-242.
37. Kunt AG,et al. Bentall prosedürü sırasında proksimal ve koroner ostiyum anastomozlarından oluşabilecek kanamaların antegrad verilen kan kardiyoplejisiyle kontrolü. Koşu Yolu Kalp Dergisi 2011;14(1):1-5.
38. Yorgancıoğlu AC, Tokmakoğlu H. Kalp cerrahisinde hemorajik ve trombotik komplikasyonlar. In: Paç M, Akçevin A, Aka SA, Büket S, Sarıoglu T, editörler. Kalp ve Damar Cerrahisi. Ankara: MN Medikal & Nobel; 2004.s. 319-29.
39. Solak H, Görmüş N. Açık kalp cerrahisinde kan koruma teknikleri. In: Duran E, editör. Kalp ve Damar Cerrahisi. İstanbul: Çapa Tıp Kitabevi; 2005. s. 1107-31.