Seksen Yaş Ve Üzeri Hastalarda Açık Kalp Cerrahisi: İki Farklı Dönemin Karşılaştırılması

Year 2022, , 330 - 334, 01.08.2022

Veysel Başar , Ayhan Güneş , Gürkan Ayaz , Mehmet Erdem Toker

https://doi.org/10.54005/geneltip.1082601

Abstract

Amaç: Çalışmada, açık kalp cerrahisi geçiren octogenarian hastalarda, ameliyat sonuçları açısından iki farklı dönemin karşılaştırılması amaçlandı.

Materyal ve metod: Kliniğimizde Ocak 2013 - Aralık 2020 yılları (grup 1:115 hasta) ile Ocak 2000 - Aralık 2007 yılları (grup 2:103 hasta) arasında açık kalp cerrahisi geçirmiş 80 yaş ve üstü 218 hasta çalışmaya dahil edilmiş ve iki gruba ayrılmıştır. Çalışma retrospektif tasarlanmış olup, iki grup arası operatif ve postoperatif veriler istatistiksel olarak karşılaştırılmıştır.

Bulgular: Gruplar arasında yaş ortalamaları ve cinsiyet dağılımları açısından istatistiksel olarak anlamlı bir farklılık bulunmamaktadır (p>0.05). Grup 2’de CABG-BH oranı (%24.5), Grup 1’den (%7.9) istatistiksel olarak anlamlı düzeyde yüksektir (p:0.002; p<0.05). Grup 1’de AVR oranı (%53.9), Grup 2’den (%10.7) istatistiksel olarak anlamlı düzeyde yüksektir (p:0.000; p<0.05). Grup 1’de mitral tamir oranı (%7.1), Grup 2’den (%1) istatistiksel olarak anlamlı düzeyde yüksektir (p:0.037; p<0.05). Grup 1’in preop ejeksiyon fraksiyonu (EF) düzeyi ortalaması, Grup 2’den istatistiksel olarak anlamlı düzeyde yüksektir (p:0.000; p<0.05). Grup 2’de lima oranı (%68), Grup 1’den (%29.8) istatistiksel olarak anlamlı düzeyde yüksektir (p:0.000; p<0.05). Kanama revizyonu, postoperatif serebrovaskuler olay ve mortalite açısından gruplararası istatistiksel anlamlı fark bulunmamıştır. En sık mortalite nedeni kardiyak nedenlerdir.

Sonuç: Seksen yaş ve üzeri hastalarda açık kalp cerrahisi, yüksek mortalite ve kabul edilebilir morbidite oranlarına sahiptir. Klinik deneyimin artması, tamir ve minimal invaziv tekniklerin gelişmesiyle birlikte, doğru hasta seçimi ve eşlik eden ek hastalıkların varlığında seçilecek uygun cerrahi yaklaşım ile daha düşük mortalite oranları sağlanabilir.

Keywords

açık kalp cerrahisi, seksen yaş ve üzeri, aort kapak replasmanı, mitral kapak replasmanı, koroner arter bypass greftleme, aort anevrizması

Supporting Institution

yok

Open Heart Surgery In Octogenarian Patients: A Comparison Of Two Eras

Abstract

Aim: In this study, it was aimed to compare two different periods in terms of surgical results in octogenarian patients who underwent open heart surgery.

Material and method: In the present study, 218 patients aged 80 and over who had undergone open heart surgery in our clinic between January 2013 and December 2020 (group 1:115 patients) and between January 2000 and December 2007 (group 2:103 patients) were included and divided into two groups. The study was designed retrospectively, and the operative and postoperative data were statistically compared between the two groups.

Results: There was no significant difference between groups in terms of mean age and gender distribution (p>0.05). Coronary artery bypass graft-beating heart prevalence in Group 2 (24.5%) was significantly higher than that in Group 1 (7.9%) (p:0.002; p<0.05). Aorta valve replacement rate in Group 1 (53.9%) was significantly higher than that in Group 2 (10.7%) (p:0.000; p<0.05). Mitral repair rate in Group 1 (7.1%) was significantly higher than that in Group 2 (1%) (p:0.037; p<0.05). The mean preop ejection fraction level of Group 1 was significantly higher than that in Group 2 (p:0.000; p<0.05). Left internal mammary artery prevalence in Group 2 (68%) was significantly higher than that in Group 1 (29.8%) (p:0.000; p<0.05). There was no statistically significant difference between groups in terms of bleeding revision, postoperative cerebrovascular event, and mortality. The most common cause of mortality was cardiac in origin.

Conclusion: Open heart surgery in octogenarian patients has high mortality and acceptable morbidity rates. With the increase in clinical experience and the development of repair and minimally invasive techniques, lower mortality rates can be achieved with the right patient selection and an appropriate surgical approach in the presence of comorbidities.

Keywords

open heart surgery, aortic valve replacement, mitral valve replacement, octogenarian patients, aortic aneurysm

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