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

Early outcomes of cardiac reoperations: Seven years of experience

Amaç: Bu çalışmada, kliniğimizde gerçekleştirilen kardiyak tekrar ameliyatlara ait erken dönem sonuçları değerlendirildi. Çalışma planı: Kliniğimizde Şubat 2001 ile Eylül 2008 tarihleri arasında gerçekleştirilen 8645 açık kalp ameliyatı içinde yer alan 127 (%1.46) kardiyak tekrar ameliyat olgusunun (76 kadın 51 erkek; ort. yaş 51.2±13.6 yıl; dağılım 11-75 yıl), tıbbi kayıtları geriye yönelik olarak incelendi. En sık rastlanan redo kardiyak ameliyat endikasyonları, daha önce tamir edilen kalp kapak lezyonlarının ilerlemesi (n=43) ve daha önce uygulanan sol internal torasik arter veya safen ven greftlerinde tıkanma olması (n=35) idi. Olguların ameliyat öncesi klinik özellikleri, ameliyat sırası bulguları ve erken dönem ameliyat sonrası seyirleri analiz edildi. Bulgular: İlk ameliyat ile tekrar ameliyat arasında geçen ortalama süre 7.5±8.0 (1-35) yıldı. Olgulardan dördü acil koşullarda ameliyat edildi. Tekrar ameliyatların temel cerrahi girişim sınıflaması şöyleydi: 35 olgu izole koroner arter bypass ameliyatı (%27.5), 70 olgu izole kalp kapağı girişimi (%55.1), 10 olgu kombine kapak artı koroner girişimi ve 12 olgu diğer girişimler. Hastane mortalite oranı %5.5 idi (7 olgu). Sonuç: Kardiyak tekrar ameliyatlar günümüzde kötü prognoza neden olacak bir risk faktörü değildir. Özgün multidisipliner yaklaşımlar göstererek, kardiyak tekrar ameliyatların güvenli ve kabul edilebilir risk profili çerçevesinde gerçekleştirilebileceğine inanıyoruz.

Kardiyak tekrar ameliyatlarında erken dönem sonuçları: Yedi yıllık deneyimimiz

Background: The aim of this study was to present and discuss the early outcomes of our cardiac reoperation cases. Methods: Between February 2001 and September 2008, 8645 patients underwent cardiac operations in our clinic. Medical records of 127 (1.46%) of them (76 females 51 males; mean age 51.2±13.6 years; range 11 to 75 years), who underwent cardiac reoperation, were retrospectively analyzed. The main reasons for redo cardiac surgery were progression of valvular diseases after repairs (n=43), occlusion of left internal thoracic artery or saphenous vein grafts (n=35). Preoperative clinical characteristics, perioperative data and early postoperative outcomes of the cases were presented. Results: The interval between the first and redo cardiac operation was 7.5±8.0 (1-35) years. Four cases were operated under emergency conditions. Types of the reoperations were as follows: 35 isolated coronary artery bypass grafting surgery (27.5%), 70 isolated valve surgery (55.1%), 10 combined valvular plus coronary artery bypass grafting surgery and 12 other types of cardiac reoperation. In-hospital mortality rate was 5.5% (7 cases). Conclusion: Reoperation itself is no longer a risk factor for poor outcome and we believe that cardiac reoperations may be done effectively and with acceptable risks when specific multidisciplinary approaches are adopted.

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