Fuat BİLGEN, Ali SANDIKÇI, Nuket BİLGİNER, Ersan ÖZBUDAK, Ali ÖZERDEM, Emre ÖZKER, Ahmet Refik TURGUT

Hemodiyalize bağımlı kronik böbrek yetmezlikli hastalarda açık kalp cerrahisi

Amaç: Kronik böbrek yetmezlikli (KBY) hastalarda kardiyak hastalıkların görülme oranı normal nüfusa göre daha yüksektir. Bu çalışmada, kalp cerrahisi uygulanan KBY'li hastaların tedavi sonuçları değerlendirildi. Çalışma planı: Çalışmaya, kardiyopulmoner bypass altında kardiyak cerrahi uygulanmış olan hemodiyalize bağımlı son dönem böbrek yetmezlikli 28 hasta (21 erkek, 7 kadın; ort. yaş 59±9; dağılım 42-76) alındı. Yirmi beş hastaya koroner bypass ameliyatı, bir hastaya koroner bypassla birlikte aort kapak replasmanı, iki hastaya ise kapak ameliyatı uygulandı. Bu olguların ameliyat öncesi, ameliyat sırasındaki ve ameliyat sonrası bulguları geriye dönük olarak incelendi.Bulgular: Ortalama kros klemp süresi 63±18 dk, toplam perfüzyon süresi ise 84±22 dk idi. Yedi hastada KPB çıkışında inotrop ihtiyacı doğmasına karşın, ameliyat sonrası birinci gün tüm hastalarda inotrop desteği sonlandırıldı. Hiçbir hastada revizyon ihtiyacı olmadı. Ortalama drenaj miktarı 440±110 ml idi. Beş hastada (%18) atriyal fibrilasyon gözlendi; bu hastaların tamamı tıbbi tedavi ile sinüs ritmine döndü. Üç hastada plevral efüzyon nedeniyle torasentez ihtiyacı oluştu. Bir hastada yara yeri infeksiyonu gözlendi. Bir hasta düşük kardiyak debi ve multiorgan yetmezliği nedeniyle kaybedildi. Hastaların yoğun bakımda kalma süresi ortalama 20±4 saat, toplam hastanede yatış süresi 7±1 gün bulundu. Tüm hastalar ameliyat sonrasında kardiyak açıdan asemptomatik olarak diyalize girmeyi sürdürdü.Sonuç: Hemodiyalize bağımlı KBY'li hastalarda klasik kardiyopulmoner bypass yöntemi kullanılarak kabul edilebilir morbidite ve mortalite ile kardiyak cerrahi uygulanabilir.

Open heart surgery in dialysis-dependent patients with chronic kidney failure

Background: Cardiac diseases are much more common in patients with chronic renal failure (CRF) than in the general population. We evaluated the results of cardiac surgery in patients with CRF. Methods: The study included 28 dialysis-dependent patients with CRF (21 males, 7 females; mean age 59±9 years; range 42 to 76 years) who underwent cardiac surgery under cardiopulmonary bypass. Of these, 25 patients underwent coronary artery bypass surgery, one patient underwent coronary artery bypass surgery and aortic valve replacement, and two patients underwent cardiac valve surgery. Preoperative, perioperative, and postoperative data of the patients were retrospectively evaluated.Results: The mean cross clamp time was 63±18 min and the mean perfusion time was 84±22 min. Seven patients needed inotropic support at the end of surgery, but inotropic support was discontinued in the first postoperative day in all the patients. None of the patients required revision. The mean amount of drainage was 440±110 ml. Five patients (18%) who developed atrial fibrillation returned to sinus rhythm after medical treatment. Three patients underwent thoracentesis due to pleural effusion. One patient developed wound infection. Mortality occurred in only one patient due to low cardiac output and multiorgan failure. The mean intensive care unit stay was 20±4 hours, and the mean hospital stay was 7±1 days. Postoperatively, all the patients continued dialysis treatment without cardiac symptoms.Conclusion: Cardiac surgery with conventional cardiopulmonary bypass techniques can be performed with acceptable morbidity and mortality rates in dialysis-dependent patients with CRF.

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