Kemal UZUN, Adil POLAT, Esat AKINCI, Cenk TATAROĞLU, Ali Rıza CENAL, Hayrettin TEKÜMİT

Does opening the pleura during internal mammary artery harvesting decrease the risk of tamponade?

Amaç: Bu çalışmada plevranın açılmasının erken ameliyat sonrası kanama veya kardiyak tamponad gelişimi sıklığı üzerindeki etkisi incelendi.Çalışma planı: Ocak 2007 - Eylül 2009 tarihleri arasında kliniğimizde koroner arter bypass greftleme (KABG) ameliyatı uygulanan toplam 2110 hastanın klinik verileri plevranın açılması ve tamponad gelişimi açısından geriye dönük olarak incelendi. Erken ameliyat sonrası kanama veya tamponad nedeniyle tekrar ameliyatına alınan 66 hasta (%3.1) tespit edildi.Bulgular: Plevranın açıldığı (n=46) ve açılmadığı (n=20) hastalardaki acil revizyon (sırasıyla %2.9 ve %3.2; p=0.85) ve tamponad oranları (sırasıyla %1.8 ve %1.3; p=0.46) benzerdi. Kanama/tamponad nedeniyle erken tekrar ameliyatı uygulanması gereken hasta alt grubunda, plevrası açılmayan hastaların 12'sinde (%60), açılanların ise 18'inde (%39.1) tamponad vardı (p=0.178). Tamponad gelişimi toplam drenaj miktarında, tekrar ameliyatına kadar geçen sürede, mekanik ventilasyon süresinde ve inotropik ajan kullanımındaki artışla ilişkiliydi.Sonuç: Koroner arter bypass greftleme sırasında internal meme arterinin çıkarılması için plevranın açılması tamponad sıklığını azaltmamaktadır. Daha büyük çalışmalara ihtiyaç duyulmasına karşın, KABG hastalarının çoğunda plevranın korunması tercih edilecek seçenek olabilir.

İnternal meme arteri çıkarılırken plevranın açılması tamponad riskini azaltır mı?

Background: In this study we investigated the effect of opening the pleura on the rates of early postoperative bleeding and/or cardiac tamponade.Methods: The clinical data of 2110 patients who underwent coronary artery bypass grafting (CABG) between January 2007 and September 2009 in our clinic were retrospectively evaluated with regard to opening of pleura and development of tamponade. Sixty-six patients (3.1%) who required reoperation due to early postoperative bleeding and/or tamponade were identified.Results: Similar rates of emergency revision (2.9% versus 3.2%, respectively; p=0.85) and tamponade (1.8% versus 1.3%, respectively; p=0.46) were observed among patients with opened pleura (n=46) and intact pleura (n=20). Among the subset of patients who required early reoperation for bleeding/tamponade, tamponade was present in 12 patients (60.0%) with intact pleura compared to 18 patients (39.1%) in whom pleura was opened (p=0.178). Development of tamponade was associated with an increased total drainage, increased time to reoperation, prolonged duration of intubation and increased use of inotropic agents.Conclusion: Opening the pleura during CABG for internal mammary artery harvesting does not decrease the incidence of tamponade. Although larger studies are required, leaving the pleura intact may be the preferred option in most CABG patients.

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