Mehmet KAPLAN, Esra ERTÜRK, Mahmut AKYILDIZ, Tamer AKSOY, Yılmaz ZORMAN, İsmail HABERAL, Mustafa ZENGİN

Comparison between pulmonary arterial and aortic root venting and their effects on pulmonary functions following CABG surgery

Amaç: Koroner arter bypass ameliyatında kullanılan pulmoner arteryel venting ya da çıkan aort kökü venting yöntemlerinin ameliyat sonrası solunum fonksiyonları üzerindeki etkileri karşılaştırıldı. Çalışma planı: Koroner arter bypass ameliyatı yapılan 301 hasta kullanılan venting yöntemine göre iki grupta incelendi. Aort kökü ventingi (grup I) 151 hastada (109 erkek, 42 kadın; ort. yaş 61±9), pulmoner arteryel ventingi (grup II) 150 hastada (79 erkek, 71 kadın; ort. yaş 61±10) kullanıldı. İki grubun amaliyat öncesi, amaliyattaki ve ameliyat sonrası verileri karşılaştırıldı.Bulgular: Ortalama anastomoz sayısı grup I'de 2.8±0.8, grup II'de 2.4±0.8 (p=0.001), kros klemp süresi grup I'de 42.7±17.4 dk, grup II'de 54.1±23.8 dk (p=0.001) bulundu. Kardiyopulmoner bypass zamanı iki grupta benzer idi (sırasıyla 86.4±56.1 dk ve 77.4±28.6 dk). Ameliyat sonrası ortalama PO2 grup I'de 92.8±4.8 mmHg, grup II'de 106.9±22 mmHg (p=0.001) bulunurken, SO2 değerleri sırasıyla 97.3±23.4% ve 96±8% idi (p=0.001). İki grup, göğüs tüpü drenaji ve kan transfüzyonu miktarları, entübasyon süresi, yoğun bakım ünitesinde ve hastanede kalış süreleri açısından anlamlı farklılık göstermedi. Nazotrakeal aspirasyon grup I'de 20 hastada (%80) gerekirken, grup II'de beş hastada (%20) gerekti (p=0.002). Bronkodilatör ihtiyacı (p=0.01) ve atriyal fibrilasyon gelişimi (p=0.02) grup II'de anlamlı derecede daha azdı. Yeniden entübasyon yedi hastada gerekti; bu hastaların hepsi grup I'de idi (p=0.001).Sonuç: Pulmoner arteryel venting ile akciğerlerin ve sol kalp boşluklarının dekompresyonu etkin bir şekilde sağlanabilir. Aortik venting yöntemiyle karşılaştırıldığında, hastaların ameliyat sonrası solunum fonksiyonları daha iyi olmaktadır.

Pulmoner arteryel venting ile aort kökü venting yöntemlerinin karşılaştırılması ve iki yöntemin koroner arter bypass cerrahisi sonrası solunum fonksiyonları üzerine etkileri

Background: We compared the effects of pulmonary artery and ascending aorta root venting on postoperative pulmonary functions following coronary artery bypass graft (CABG) surgery. Methods: A total of 301 patients undergoing CABG were divided into two groups according to the method of venting. Aortic root venting (group I) was performed in 151 patients (109 males, 42 females; mean age 61±9 years), and pulmonary arterial venting (group II) was performed in 150 patients (79 males, 71 females; mean age 61±10 years). Preopererative, intraoperative, and postoperative findings were compared.Results: The mean number of anastomoses was 2.8±0.8 in group I, and 2.4±0.8 in group II (p=0.001). The mean duration of cross clamping was 42.7±17.4 min in group I, and 54.1±23.8 min in group II (p=0.001). The two groups did not differ with respect to the mean duration of cardiopulmonary bypass (86.4±56.1 min vs 77.4±28.6 min). The mean postoperative PO2 was 92.8±4.8 mmHg in group I, and 106.9±22 mmHg in group II (p=0.001). The corresponding figures for SO2 were 97.3±23.4% and 96±8%, respectively (p=0.001). The amount of chest tube drainage and blood transfusion, intubation time, intensive care unit stay, and hospital stay were similar in the two groups. Nasotracheal aspiration was required in 20 patients (80%) in group I, and in five patients (20%) in group II (p=0.002). The need for bronchodilator treatment and the development of atrial fibrillation were significantly less in group II (p=0.01 and p=0.02, respectively). All the patients that needed reintubation (n=7) were in group I (p=0.001).Conclusion: Pulmonary arterial venting enables effective decompression of the lungs and left ventricle and is associated with better postoperative pulmonary functions compared to aortic venting.

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1) Roberts AJ, Faro RS, Williams LA, Cohen JA, Knauf DK, Alexander JA. Relative efficacy of left ventricular venting and venous drainage techniques commonly used during coronary artery bypass graft surgery. Ann Thorac Surg 1983; 36:444-52.
2) Mills SA, Hansen K, Vinten-Johansen J, Howe HR, Geisinger KR, Cordell AR. Enhanced functional recovery with venting during cardioplegic arrest in chronically damaged hearts. Ann Thorac Surg 1985;40:566-73.
3) Baile EM, Ling H, Heyworth JR, Hogg JC, Pare PD. Bronchopulmonary anastomotic and noncoronary collateral blood flow in humans during cardiopulmonary bypass. Chest 1985;87:749-54.
4) Little AG, Lin CY, Wernly JA, Langmuir VK, Bilfinger TV, Levett JM, et al. Use of the pulmonary artery for left ventricular venting during cardiac operations. J Thorac Cardiovasc Surg 1984;87:532-8.
5) Laughlin LL, Holland DL, Wareham EE. Left heart decompression via the pulmonary artery. Thorac Cardiovasc Surg 1983;31:117-8.
6) Salomon NW, Copeland JG. Single catheter technique for cardioplegia and venting during coronary artery bypass grafting. Ann Thorac Surg 1980;30:88-9.
7) Catinella FP, Knopp EA, Cunningham JN Jr, Adams PX. A simplified method for delivery of cold blood cardioplegia and aortic root venting during coronary artery bypass. J Cardiovasc Surg 1982;23:163-5.
8) Cave AC, Manche A, Derias NW, Hearse DJ. Thromboxane A2 mediates pulmonary hypertension after cardiopulmonary bypass in the rabbit. J Thorac Cardiovasc Surg 1993; 106:959-67.
9) Tennenberg SD, Clardy CW, Bailey WW, Solomkin JS. Complement activation and lung permeability during cardiopulmonary bypass. Ann Thorac Surg 1990;50:597 601.
10) Westaby S. Organ dysfunction after cardiopulmonary bypass. A systemic inflammatory reaction initiated by the extracorporeal circuit. Intensive Care Med 1987;13:89-95.
11) Brigham KL. Mechanism of lung injury. Eur Respir Rev 1992; 2:16-8.
12) Macnaughton PD, Braude S, Hunter DN, Denison DM, Evans TW. Changes in lung function and pulmonary capillary permeability after cardiopulmonary bypass. Crit Care Med 1992;20:1289-94.
13) Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988;138:720-3.
14) Moat NE, Shore DF, Evans TW. Organ dysfunction and cardiopulmonary bypass: the role of complement and complement regulatory proteins. Eur J Cardiothorac Surg 1993;7: 563-73.
15) Roach GW, Bellows WH. Left ventricular distention during pulmonary artery venting in a patient undergoing coronary artery bypass surgery. Anesthesiology 1992;76:655-8.
16) Ege T, Huseyin G, Yalcin O, Us MH, Arar C, Duran E. Importance of pulmonary artery perfusion in cardiac surgery. J Cardiothorac Vasc Anesth 2004;18:166-74.
17) Dodd-o JM, Welsh LE, Salazar JD, Walinsky PL, Peck EA, Shake JG, et al. Effect of bronchial artery blood flow on cardiopulmonary bypass-induced lung injury. Am J Physiol Heart Circ Physiol 2004;286:H693-700.