Mehmet BALKANAY, Murat Bülent RABUŞ, Mehmet Erdem TOKER, Hüseyin ANASIZ, Cevat YAKUT, Ercan EREN, Mustafa GÜLER, Ahmet ÇALIŞKAN

Kalp ameliyatlarında kanama nedeniyle revizyon: Bir merkezin on senelik sonuçları

Amaç: Bu çalışmanın amacı; on senelik dönemde yapılan kalp ameliyatlarında kanama nedeniyle revizyon oranını ortaya koymaktır.Çalışma planı: Çalışmaya, Ocak 1995 - Aralık 2004 tarihleri arasında kardiyopulmoner bypass (KPB) yapılmış olan bütün açık kalp ameliyatları ve atan kalpte koroner arter bypass (AKKAB) işlemleri alındı (13051 ameliyat). Hastalar, kapak ±koroner arter bypass greftleme (KABG); KABG-KPB; AKKAB; KPB'de yapılan doğuştan ameliyatlar; asandan ve/veya arkus aorta cerrahisi ve diğerleri olmak üzere altı gruba ayrıldı, bu yöntemlerde kanama nedeniyle gereksinim duyulan revizyon ameliyatlarının (165 revizyon; 130 erkek, 35 kadın; ort. yaş 53.1±16.8; dağılım 5-84) oranları incelendi.Bulgular: Kanama nedeniyle revizyon oranı, on yıllık dönemde %1.2'ydi. Ocak 1995-Aralık 1999'u kapsayan ilk beş yılda revizyon oranı %1.1 iken, Ocak 2000-Aralık 2004 arasında %1.4'tü. Hasta alt gruplarına göre en büyük revizyon oranı %4.7 ile asandan ve arkus aorta cerrahisinde, en küçük oran %0.9 ile AKKAB grubunda bulundu. Bu oranlar kapak ±KABG grubunda %1.6, KABG-KPB'de %1, KPB'de yapılan doğuştan ameliyatlarda %1.1'di. Hastane mortalitesi %6.6 olarak bulundu. Hastaların %84'ü erken dönemde, %16'sı ise geç dönemde revizyona alındı. Geç dönemde revizyona alınan 26 hastanın 19'u, mekanik kapak replase edilmesi nedeniyle oral antikoagülan kullanıyordu.Sonuç: Kanama nedeniyle revizyon oranı, ikinci beş yılda %1.1'den %1.4'e yükselmiştir. Bu durumun acil ya da yarı acil hasta sayısındaki artışa veya ameliyat öncesi kondisyonu daha kötü olan hasta sayısındaki yükselmeyle ilişkili olabileceği düşünüldü. Mekanik kapak replasmanı yapılıp, oral antikoagülan kullanan hastalara erken dönemde ekokardiyografik kontrol yapılması perikardiyal efüzyon varlığını ortaya koyacaktır. Bu, takip döneminde girişim gerekip gerekmeyeceği konusunda yararlı olacaktır.

The revision due to bleeding in heart operations: results of a centre in ten years period

Background: The purpose of this study is to determine the reexploration rate for bleeding in heart operations in ten years period.Methods: The study comprised all patients undergoing cardiopulmonary bypass (CPB) during open heart surgery and OPCAB procedure between January 1995 - December 2004 (13051 operations). Patients were divided into six groups as follows; valve replacement±Coronary artery bypass grafting (CABG), CABG-CPB, OPCAB, congenital operations with cardiopulmonary bypass, ascending and/or arcus aortic surgery and others. Overall reexploration rate for bleeding was assessed for each group (165 revisions; 130 males, 35 females; mean age 53.1±16.8 years; range 5 to 84 years).Results: Overall reexploration rate for bleeding was 1.2% (165/13051) in ten years period. The reexploration rate was 1.1% (67/6120) during the first 5-year period (1995-1999) and 1.4% (98/6931) during the second 5-year period (January 2000-December 2004). In subgroup analysis; reexploration rate was highest in the ascending and arcus aortic surgery subgroup (4.7%) and lowest in the OPCAB subgroup (0.9%). Overall in-hospital mortality rate was 6.6% (11/165). Early revision rate was 84% (139/165) and late revision rate was 16% (26/165). Nineteen of the 26 patients in late revision group were on oral anticoagulant treatment due to mechanical valve replacement.Conclusion: Reexplorations rate for bleeding has increased from 1.09% to 1.4% during the second 5-year period. This may be due to an increase in the number of patients in urgent or emergent conditions or to the increase of the number of patients with worse preoperative conditions than before. Echocardiographic examination in patients with replaced mechanical valves and on oral anticoagulants in the early postoperative period would reveal the presence of pericardial effusion. This would be useful to determine the necessity of surgical intervention in the follow-up period.

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