Mehmet BALKANAY, İlker MATARACI, Rahmi ZEYBEK, Mehmet Erdem TOKER, Cevat YAKUT, Ercan EREN, Ahmet ÇALIŞKAN, Hasan Basri ERDOĞAN

Seksen yaş ve üzerindeki hasta nüfusunda açık kalp cerrahisi ameliyatları ve sonuçları

Amaç: Bu çalışmada, 80 yaş ve üzerindeki hasta grubunda uygulanmış olan açık kalp cerrahisi ameliyatlarının sonuçları incelendi. Çalışma planı: Çalışmaya kliniğimizde Ocak 2000-Mayıs 2007 arasında açık kalp cerrahisi uygulanan 103 hasta (60 erkek, 43 kadın; ort. yaş 81.3±2.4 yıl; dağılım 80-93 yıl) dahil edildi. Kırk yedi (%45.6) hastaya kardiyopulmoner bypassta koroner arter bypass greftleme (KABG), 25 hastaya (%24.3) atan kalpte koroner arter bypass (AKKAB), 11 hastaya (%10,7) aort kapak replasmanı (AKR), altı hastaya (%5.8) KABG + AKR, dört hastaya (%3.9) KABG + Mitral kapak replasmanı (MKR), üç hastaya (%2.9) KABG + Mitral rekonstrüksiyon, iki hastaya (%1.9) AKR + MKR, iki hastaya (%1.9) KABG + Karotis endarterektomi, bir hastaya (%0.9) MKR, bir hastaya (%0.9) AKR + Mitral rekonstrüksiyon, bir hastaya (%0.9) mitral rekonstrüksiyon ameliyatı yapılmıştır. Bulgular: Erken mortalite 24 hasta ile %23.3 oldu. Düşük kardiyak debi görülme insidansı %28.2 (n=29) idi. Perioperatif miyokard infarktüsü sekiz hastada (%7.8), mediastinit altı hastada (5.8) görüldü. Ameliyat sonrası beş hastada (%4.9) serebrovasküler sorun gelişti. Üç hastada (%2.9) kanama nedeniyle revizyon yapıldı. Üç hastaya (%2.9) kalp pili takıldı. On dört hastaya (%13.6) damar içi balon pompası yerleştirildi. Univaryant analizde; uzamış aortik kros klemp (AKK) zamanı (p=0.004), olguların ameliyat öncesi NYHA klass III veya IV olması (p=0.007), kronik obstrüktif akciğer hastalığı (KOAH) varlığı (p=0.049) ve ameliyat sırasında kapak girişimi yapılması (izole kapak ve kapak + koroner) (p=0.019) erken mortalite için anlamlı bulundu. Multivaryant analizde mortaliteyi etkileyen belirleyiciler ise; hastaların ameliyat öncesi NYHA klass III veya IV olması (p=0.009), sol ventrikül ejeksiyon fraksiyonunun %50’nin altında olması (p=0.046) ve kapak girişimi yapılması (izole kapak ve kapak + koroner; p=0.009) olarak bulundu. Sonuç: Seksen yaş ve üzerindeki hasta nüfusunda açık kalp cerrahisi, yüksek cerrahi mortalite ve kabul edilebilir morbidite ile gerçekleştirilebilir. Eşlik eden hastalıkların varlığında uygulanacak cerrahi tekniğin belirlenmesi ile daha düşük mortalite sağlanabilir.

Open heart surgery and results in patient population aged 80 years and older

Background: The aim of this study was to evaluate the results of open heart surgery operations in patients aged 80 and over. Methods: The study includes 103 patients (60 males, 43 females; mean age 81.3±2.4 years; range 80 to 93 years) who underwent open heart surgery in our clinic between January 2000 and May 2007. Fourty seven patients (45.6%) underwent on-pump coronary artery bypass grafting (CABG), 25 (24.3%) were off pump coronary artery bypass (OPCAB), 11 (10.7%) were aortic valve replacement (AVR), six (5.8%) were CABG + AVR, four (3.9%) were CABG + Mitral valve replacement (MVR), three (2.9%) were CABG + Mitral reconstruction, two (1.9%) were AVR + MVR, two were (1.9%) CABG + Carotis endarterectomy, one (0.9%) was MVR, one (0.9%) was AVR + Mitral reconstruction, and one (0.9%) was mitral reconstruction. Results: Early mortality was 23.3% with 24 patients. The incidence of low cardiac output syndrome (LCOS) was 28.2% (29 patients). Perioperative myocardial infarction occured in eight patients (7.8%), mediastinitis occured in six patients (5.8%). Postoperative cerebrovascular problems developed in five patients (4.9%). Revision due to bleeding is applied in three patients (2.9%). Permanent pacemaker is implanted in three patients (2.9%). Intraaortic balloon pump was inserted in 14 (13.6%) patients. Univariant determinants were longer aortic cross clamp time (p=0.004), preoperative NYHA class III and IV (p=0.007), chronic obstructive pulmonary disease (COPD, p=0.049), valvular surgery (isolated valve or valvular and coronary intervention, p=0.019). Multivariant determinants affecting the mortality were patients’ being in NYHA class III or IV (p=0.009) preoperatively, left ventricular ejection fraction lower than 50%, and valvular surgery (isolated valve or valvular and coronary intervention, p=0.009). Conclusion: Open heart surgery in patients at the age of 80 and over can be performed with high mortality and acceptable morbidity. In the presence of comorbid diseases, lower mortality can be achieved with the determination of the surgical technique to be performed.

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