Mustafa PAÇ, Zeki ÇATAV, Levent ALTINAY, S. Fehmi KATIRCIOĞLU, Ahmet SARITAŞ, Soner YAVAŞ

Koroner arter bypass greftleme ameliyatı yapılan hastalarda pulmoner hipertansiyonun cerrahi sonuç üzerine etkisi

Amaç: Bu geriye yönelik çalışmada, koroner arter bypass greftleme (KABG) ameliyatı yapılan hastalarda ameliyat öncesinde var olan pulmoner hipertansiyonun başta hastane mortalitesi olmak üzere çeşitli klinik değişkenlere etkisi araştırıldı.Çalışma planı: Kliniğimizde Ocak 2000 - Mayıs 2006 tarihleri arasında izole KABG ameliyatı yapılmış ve ameliyat öncesi dönemde ekokardiyografik olarak tespit edilmiş pulmoner hipertansiyonu olan hastalar geriye yönelik olarak incelendi. İskemik kalp hastalığı dışında pulmoner hipertansiyonu açıklayacak patolojisi olmayan 177 hasta çalışmaya dahil edildi. Hastalar üç gruba ayrıldı. Sistolik pulmoner arter basıncı (sPAB) 30 mmHg ve altında olan hastalar "sPAB normal olan grup" (grup 1), sPAB 30-50 mmHg arası olanlar "orta derecede pulmoner hipertansiyonlu" (grup 2) ve sPAB 50 mmHg ve üzerinde olanlar "ileri derecede pulmoner hipertansiyonlu" (grup 3) hastalar olarak belirlendi. Gruplar, kardiyopulmoner bypass (KPB) süresi, aortik kros-klemp süresi, mekanik ventilasyon süresi, perioperatif inotropik destek ihtiyacı, perioperatif intra-aortik balon pompası (İABP) ihtiyacı ve hastane mortalitesi açısından değerlendirildi.Bulgular: Gruplara göre hastane mortaliteleri, grup 1'de %4.7, grup 2'de %10, grup 3'de ise %18.9 oldu, grup 1 ile 3 arasındaki fark anlamlı bulundu (p=0.02). Gruplar arasında ameliyat süresi, KPB süresi ve aortik kros-klemp süresi açısından fark anlamlı bulunmadı. Grup 1 ile 3 arasında, perioperatif inotropik destek ihtiyacı (p=0.001), perioperatif İABP ihtiyacı (p=0.01) yönünden farklılıklar anlamlı bulundu. Ayrıca, çalışma yapılan tüm hastalarda, ortalama sol ventrikül ejeksiyon fraksiyonu ile sistolik pulmoner basınç arasında negatif bir ilişki (Pearson korelasyon katsayısı: -0.429; p

The effect of pulmonary hypertension on surgical outcome in patients undergoing coronary artery bypass grafting

Background: In this retrospective study, the impact of preoperatively existent pulmonary hypertension on hospital mortality and certain clinical indices in patients undergoing coronary artery bypass grafting (CABG) was investigated.Methods: The patients having pulmonary hypertension detected by preoperative echocardiography among those undergoing isolated CABG in our clinic between January 2000 and May 2006 were retrospectively reviewed. One hundred and seventy-seven cases with no possible etiologies other than ischemic heart disease to explain elevated pulmonary pressures were included in the study. The patients were then divided into three groups. Patients with a pulmonary artery systolic pressure (PASP) below 30 mmHg were assigned to the "normal PASP group" (group 1), those with a PASP between 30-50 mmHg were assigned to the "mild pulmonary hypertension group" (group 2) and those with a PASP above 50 mmHg were assigned to the "severe pulmonary hypertension group" (group 3). These three groups were then compared as to cardiopulmonary bypass (CPB) and aortic cross-clamp durations, mechanical ventilation duration, perioperative inotropic support or intra-aortic baloon pump (IABP) requirement and hospital mortality.Results: The hospital mortalities were 4.7%, 10%, 18.9% for the groups 1, 2 and 3, respectively. The difference between the hospital mortalities of group 1 and 3 was significant (p=0.02). There was no significant difference between the groups in terms of operation time, CPB and aortic cross-clamp durations. However, the difference between the groups 1 and 3, in regard to perioperative inotropic support and IABP need, was significant (p=0.001 and p=0.01, respectively). In addition, there was a negative correlation between the average left ventricular ejection fraction and pulmonary pressure (Pearson's correlation coefficient: -0.429; p

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