Mustafa BÜYÜKATEŞ, Tolga KURT, Özer KANDEMİR, Sait Mesut DOĞAN, S.Akın TURAN, Elif CEYLAN, Hilmi TOKMAKOĞLU

Kronik obstrüktif akciğer hastalığının yaygın olduğu bir bölgede koroner bypass cerrahisi sonuçları

Amaç: Bu çalışmada, kronik obstrüktif akciğer hastalığının (KOAH) yaygın olduğu Zonguldak bölgesinde yapılan koroner bypass cerrahisi sonuçları değerlendirildi ve KOAH’nin mortalite ve morbidite üzerine etkisi araştırıldı. Çalışma planı: Çalışmaya, koroner bypass cerrahisi uygulanan 102 hasta alındı. Ameliyat öncesinde yapılan solunum fonksiyon testlerinde 40 hastada (%39.2) KOAH tanısı kondu (grup 1). Bu hastalar ile solunum fonksiyon testleri normal olan 62 hasta (grup 2) mortalite ve morbidite yönünden karşılaştırıldı.Bulgular: Ameliyat sonrası dönemde düşük debi gelişimi, kanama nedenli revizyon, atriyal fibrilasyon, intra-aortik balon pompası kullanımı, uzun süreli entübasyon, enfeksiyon gelişimi açısından iki grup arasında anlamlı fark bulunmadı. Yoğun bakımda ve hastanede kalış süreleri grup 1’de anlamlı derecede daha uzundu (sırasıyla, p=0.004 ve p=0.01). Mortalite grup 1’de bir hastada (%2.5) görülürken, grup 2’de görülmedi. Lojistik regresyon analizinde aortik kros klemp zamanı ve kardiyopulmoner bypass süresi mortaliteye etkili bağımsız faktörler olarak bulundu (sırasıyla, p=0.02 ve p=0.005).Sonuç: Daha önceleri görece cerrahi kontrendikasyonlar arasında sayılan KOAH riski, açık kalp cerrahisi tekniklerinde, yoğun bakım ve anestezi ünitelerindeki gelişmelere paralel olarak azalmıştır.

The results of coronary artery bypass surgery in a region with a high incidence of chronic obstructive pulmonary disease

Background: We evaluated the results of coronary artery bypass surgery and the effect of chronic obstructive pulmonary disease (COPD) on mortality and morbidity in patients living in Zonguldak, where the incidence of COPD is high. Methods: The study included 102 patients undergoing coronary artery bypass surgery. Preoperative respiratory function tests showed COPD in 40 patients (39.2%, group 1) and no COPD in 62 patients (group 2). The two groups were compared with respect to postoperative mortality and morbidity.Results: There were no significant differences between the two groups with respect to low cardiac output, reoperation due to hemorrhage, atrial fibrillation, use of intra-aortic balloon pump, prolonged intubation, and infection. Intensive care unit stay and the length of hospitalization were significantly longer in group 1 (p=0.004 and p=0.01, respectively). Mortality occurred in one patient (2.5%) in group 1, whereas there was no mortality in group 2. In logistic regression analysis, aortic cross-clamp time and duration of cardiopulmonary bypass were found to be predictors of mortality (p=0.02 and p=0.005, respectively).Conclusion: While COPD was a relative contraindication for coronary artery bypass surgery in former years, the risk is reduced in parallel with advances in open heart surgery, and improvements in intensive care and anesthesiology units.

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