Çalışan kalpte yapılan koroner bypass cerrahisi sırasında kardiyopulmoner bypassa dönüşümün mortalite ve morbidite üzerine
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Date
2012
Authors
Önder, Tolga
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Çalışan kalpte koroner bypass operasyonları günümüzde hızla artan oranlarda uygulanmaktadır ve pek çok rapor hastane ve kısa dönem mortalite ve morbiditenin kardiopulmoner bypass eşliğinde yapılan operasyonlara göre daha az olduğunu göstermektedir. Fakat genelde çalışan kalpte yapılan operasyonların kardiyopulmoner bypass a dönüşümünden bahsedilmemektedir. Acil konversiyon, çalışan kalpte CABG operasyonu uygulanması sırasında hemodinamik bozulma, hemoraji, iskemik epizot ve kardiyak arrest gibi nedenleri takiben kardiyopulmoner bypass kullanılması olarak tanımlanır. Bu çalışmanın amacı planlı off pump koroner bypass cerrahisi sırasında acil kardiopulmoner bypassa konversiyonun sonuçlarını değerlendirmek ve konversiyon hastalarının sonuçlarını kardiyopulmoner bypass eşliğinde yapılan koroner bypass operasyonları ile retrospektif olarak karşılaştırmaktı.Uludağ Üniversitesi Tıp Fakültesinde Ocak 2004-Ocak 2010 tarihleri arasında 1257 izole çalışan kalpte koroner bypass operasyonu ve 494 izole konvansiyonel koroner bypass operasyonu uygulandı. 66 hastada (%5.4) acil kardiyopulmoner bypassa konversiyon gereksinimi oldu.Kardiyopulmoner bypassa konversiyon olan hastalar, konvansiyonel cerrahi ile karşılaştırıldığında, mortalitenin (p=0.003), intraaortik balon pompa kullanımının (p=0.007), ventilasyon süresinin (p=0.02), KPB süresinin (p=0.002), operasyon süresinin (p=0.001), inotrop ihtiyacının (p<0.001), aritmi insidansının (p<0.001), hastanede kalış süresinin (p<0.001), göğüs tüpü drenajınını (p=0.023) önemli derecede yüksek olduğu görüldü.Off pump koroner bypass cerrahisi esnasında acil kardiyopulmoner bypassa konversiyon olması yüksek mortalite ve morbidite ile sonuçlanır. Off pump koroner bypass cerrahisi ile konvansiyonel cerrahiyi karşılaştıran çalışmalarda konversiyon hastaları off pump grubuna dahil edilmelidir.
Off-pump coronary artery bypass surgery (OPCAB) is being increasingly performed and many reports have shown reduced in-hospital and short-term morbidity in comparison with conventional coronary bypass grafting performed during cardiopulmonary bypass (CPB). Most of these reports mention emergency conversion to CPB during attempted OPCAB. However, OPCAB is sometimes converted acutely to CABG-CPB. Emergency conversion was defined as use of CPB after the initial intent of performing OPCAB if the reason for using CPB was any of the following; hemodynamic compromise,hemorrhage, ischemic episodes, and cardiac arrest. The purpose of this study was to evaluate outcomes of emergency conversion to cardiopulmonary bypass during planned off-pump coronary artery bypass grafting and compare patients outcomes for acutely converted OPCAB with CABG-CPB in retrospective.From January 2004 through January 2010, 1257 consecutive isolated off pump coronary artery bypass operations and 494 isolated convantionel coronary artery bypass operations were performed at Uludag University Medical Faculty. Sixty six (5.4%) patients required emergency conversion to cardiopulmonary bypass.Those converted to cardiopulmonary bypass had significantly higher rates of mortality (p=0.003), intraaortic balloon pumping (p=0.007), ventilation time (p=0.02), CPB time (p=0.002), operation time (p=0.001), need for inotrop (p<0.001), incidance of arrhythmia (p<0.001), hospital stay (p<0.001), chest tube drainage (p=0.023) compared to convantionel CABGEmergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery results in significantly higher morbidity and mortality. Studies comparing off-pump coronary bypass surgery with conventional coronary artery surgery should include converted patients in the off-pump group.
Off-pump coronary artery bypass surgery (OPCAB) is being increasingly performed and many reports have shown reduced in-hospital and short-term morbidity in comparison with conventional coronary bypass grafting performed during cardiopulmonary bypass (CPB). Most of these reports mention emergency conversion to CPB during attempted OPCAB. However, OPCAB is sometimes converted acutely to CABG-CPB. Emergency conversion was defined as use of CPB after the initial intent of performing OPCAB if the reason for using CPB was any of the following; hemodynamic compromise,hemorrhage, ischemic episodes, and cardiac arrest. The purpose of this study was to evaluate outcomes of emergency conversion to cardiopulmonary bypass during planned off-pump coronary artery bypass grafting and compare patients outcomes for acutely converted OPCAB with CABG-CPB in retrospective.From January 2004 through January 2010, 1257 consecutive isolated off pump coronary artery bypass operations and 494 isolated convantionel coronary artery bypass operations were performed at Uludag University Medical Faculty. Sixty six (5.4%) patients required emergency conversion to cardiopulmonary bypass.Those converted to cardiopulmonary bypass had significantly higher rates of mortality (p=0.003), intraaortic balloon pumping (p=0.007), ventilation time (p=0.02), CPB time (p=0.002), operation time (p=0.001), need for inotrop (p<0.001), incidance of arrhythmia (p<0.001), hospital stay (p<0.001), chest tube drainage (p=0.023) compared to convantionel CABGEmergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery results in significantly higher morbidity and mortality. Studies comparing off-pump coronary bypass surgery with conventional coronary artery surgery should include converted patients in the off-pump group.
Description
Keywords
Koroner bypass, Off pump koroner bypass, Konversiyon, Mortalite, Morbidite, CABG, OPCAB, Conversion, Mortality, Morbidity
Citation
Önder, T. (2012). Çalışan kalpte yapılan koroner bypass cerrahisi sırasında kardiyopulmoner bypassa dönüşümün mortalite ve morbidite üzerine. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.