Kalp Cerrahisi Olan Hastalarda Minimal Ekstrakorporeal Dolaşım ve Konvansiyonel Dolaşım Sistemlerinin Karşılaştırılması

Yıl 2022, Cilt: 9 Sayı: 2, 208 - 215, 30.06.2022

Gönül Erkan , Mehmet Ali Yürük

https://doi.org/10.34087/cbusbed.1020098

Öz

Giriş Amaç: Kalp cerrahisinde kardiyopulmoner bypass sırasında oluşan sistemik inflamatuar yanıt sendromu ve hemodilüsyon; morbitide ve mortalite üzerinde önemli birer etkendir. Bu sorunu azaltmaya yönelik ekstrakorporeal dolaşım sistemleri modifiye edilmiş ve minimal ekstrakorporeal dolaşım sistemi (MECC) olarak adlandırılmıştır. Çalışmamızda izole koroner arter bypass greft (KABG) cerrahisi geçiren hastalarda; MECC ile konvansiyonel ekstrakorporeal dolaşım sistemi kullanımını karşılaştırarak sonuçlarını paylaşmayı amaçladık.

Materyal ve metod: Çalışma kliniğimizde 1 Eylül 2013 ile 31 Aralık 2018 tarihleri arasında izole KABG cerrahisi yapılan hastalar üzerinde retrospektif olarak yapıldı. Hastalar; MECC ekstrakorporeal dolaşım sistemi kullanılanlar (Grup 1) ve konvansiyonel ekstrakorporeal dolaşım sistemi kullanılanlar (Grup 2) olarak iki gruba ayrıldı.

Bulgular: Çalışma MECC kullanılan 71 hasta (Grup 1), konvansiyonel ekstrakorporeal dolaşım sistemi kullanılan 69 hasta (Grup 2) olmak üzere toplam 140 hasta üzerinde yapıldı. MECC kullanılan grubun daha ileri yaşlı, kronik obstruktif akciğer hastalığının, ASA ve New York Kalp Derneği fonksiyonel sınıflama değerinin daha yüksek olduğu saptandı, p<0.05. Konvansiyonel ekstrakorporeal dolaşım sistemi kullanılan hastalarda aktive pıhtılaşma zamanı, priming solüsyonu, eritrosit transfüzyonu ve taze donmuş plazma transfüzyonu değerlerinin daha yüksektir, p < 0.05. Postoperatif veriler için yapılan karşılaştırmada grup 1’in hemotokrit değerinin yüksek, drenajın daha az ve kreatinin değerinin düşük ve entübasyon ile yoğun bakımda yatış süresinin daha kısa olduğu ve bu sonuçların istatiksel olarak anlamlı olduğu saptandı p<0.05.

Sonuç: MECC sisteminin konvansiyonel sistem gibi güvenli ve kullanışlı bir ekstrakorporeal dolaşım sistemi olduğunu belirtebiliriz. Bu konuda daha fazla hasta sayısı ve prospektif çalışmalara da ihtiyaç vardır.

Anahtar Kelimeler

Kalp cerrahisi, kardiyopulmoner bypass, Minimal Ekstrakorporeal Dolaşım Sistemi

Comparison of Minimal Extracorporeal Circulation and Conventional Circulatory Systems in Patients with Cardiac Surgery

Öz

Introduction and Aim: Systemic inflammatory response syndrome and hemodilution during cardiopulmonary bypass are important factors in morbidity and mortality. Extracorporeal circulatory systems were modified to reduce this problem and the minimal extracorporeal circulatory system (MECC) was developed. Our study aimed to compare the MECC and conventional extracorporeal circulatory systems in patients who underwent isolated coronary artery bypass graft (CABG) surgery.
Materials and Methods: The study was conducted retrospectively on patients who underwent isolated CABG surgery in our clinic between September 1, 2013-December 31, 2018. The patients were divided into those in whom the MECC system (Group 1) and the conventional extracorporeal circulatory system (Group 2) were used.
Results: The study was performed on a total of 140 CABG patients, 71 of which were performed with MECC (Group 1) and 69, with the conventional extracorporeal circulatory system (Group 2). Group 1 had higher mean age, ASA, and New York Heart Association values, and an increased rate of chronic obstructive pulmonary disease (p<0.05 for all). The activated clotting time, priming solution use, as well as the amounts of erythrocyte and fresh frozen plasma transfusion were higher in patients in whom the conventional extracorporeal circulatory system was used (p<0.05 for all). Postoperatively, the hematocrit value of Group 1 was higher, they had less drainage, and the creatinine value, and the length of intubated stay in the intensive care unit were shorter compared to Group 2 (p<0.05 for all).
Conclusion: The MECC system is a safe and useful extracorporeal circulatory system, similar to the conventional system. However, further prospective studies with a higher number of patients are needed to confirm our results.

Anahtar Kelimeler

Cardiac surgery, Cardiopulmonary bypass, minimal extracorporeal circulatory system

Kaynakça

• 1. Demirkılıç U, editör. (2008). Ekstrakorporal Dolaşım 1. Baskı. Ankara: Seçkin Yayınevi .
• 2. Journois D, Israel-Biet D, Pouard P, Rolland B, Silvester W, Vouhé P,et al. High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children. Anesthesiology. 1996 Nov;85(5):965-76. doi: 10.1097/00000542-199611000-00003. PMID: 8916812.
• 3. Wang MJ, Chiu IS, Hsu CM, Wang CM, Lin PL, Chang CI, et al. Efficacy of ultrafiltration in removing inflammatory mediators during pediatric cardiac operations. Ann Thorac Surg. 1996 Feb;61(2):651-6. doi: 10.1016/0003-4975(95)00974-4. PMID: 8572782.
• 4. Boodhwani M, Hamilton A, Varennes B, Mesana T, Wells GA, Nathan H, et al. A multicenter randomized controlled trial to assess the feasibility of testing modified ultrafiltration as a blood conservation technology in cardiac surgery. J Thorac Cardiovasc Surg. 2010; 139(3): 701-6.
• 5. Ozyaprak B, Kahraman N. Our ultrafiltration experience in open heart surgery patients with chronic renal failure. Ann Clin Anal Med. 2020;11 (Suppl 2): 105-109.
• 6. Vohra HA, Whistance R, Modi A, Ohri SK. The inflammatory response to miniaturised extracorporeal circulation: a review of the literature. Mediators Inflamm. 2009;2009:707042. doi: 10.1155/2009/707042. Epub 2010 Jan 13. PMID: 20101278; PMCID: PMC2809242.
• 7. Kofidis T, Baraki H, Singh H, Kamiya H, Winterhalter M, Didilis V, et al. The minimized extracorporeal circulation system causes less inflammation and organ damage. Perfusion. 2008 May; 23(3):147-51.
• 8. Haneya A, Philipp A, Schmid C, Diez C, Kobuch R, Hirt S,et al. Minimised versus conventional cardiopulmonary bypass: outcome of high-risk patients. Eur J Cardiothorac Surg. 2009 Nov;36(5):844-8. doi: 10.1016/j.ejcts.2009.05.045. Epub 2009 Aug 19. PMID: 19695898.
• 9. Ozyaprak B, Kahraman N. The effect of hypoalbuminema on postoperative mortality and morbidity in open heart surgery. Int J Clin Exp Med 2020;13(3):1704-1711. 10. Parolari A, Alamanni F, Polvani G, Agrifoglio M, Chen YB, Kassem S, et al. Meta-Analysis of Randomized Trials Comparing Off-Pump With On-Pump Coronary Artery Bypass Graft Patency. Ann Thorac Surg 2005; 80:2121–5.
• 11. Puehler T, Haneya A, Philipp A, Wiebe K, Keyser A, Rupprecht L, et al. Minimal Extracorporeal Circulation: An Alternative for On-Pump and Off-Pump Coronary Revascularization. The Ann of Thorac Surg 2009; 87-3: 766-772.
• 12. Bauer A, Diez C, Schubel J, El-Shouki N, Metz D, Eberle T, et al. Evaluation of Hemodynamic and Regional Tissue Perfusion Effects of Minimized Extracorporeal Circulation (MECC®). The Journal of extra-corporeal technology. 2010; 42(1); 30.
• 13. Kara KA, Öntaş H. Tranexamic Acid, a Low-cost and Practical Hemostatic Agent Against Diffuse Microvascular Bleeding Due to Coagulopathy in Heart Surgery. EJCM 2019;7(1):16-21.
• 14. Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Annals of Thoracic surgery. 2002;74: 1180-6.
• 15. Kuduvalli M, Oo AY, Newall N, Grayson AD, Jackson M, Desmond MJ, et al. Effect of peri-operativered blood cell transfusion on 30- day and 1-year mortality following coronary artery bypass surgery. European journal of Cardiothoracic surgery. 2005;27: 592-8.
• 16. Remadi JP, Marticho P, Butoi I, Rakotoarivelo Z, Trojette F, Benamar A, et al. Clinical experience with the mini- extracorporeal circulation system: an evolution or a revolution? Ann Thorac Surg. 2004 Jun; 77(6): 2172-5.
• 17. Ohata T, Mitsuno M, Yamamura M, Tanaka H, Kobayashi Y, Ryomoto M, et al. Beneficial effects of mini-cardiopulmonary bypass on hemostasis in coronary artery bypass grafting: analysis of inflammatory response and hemodilution. ASAIO J. 2008 Mar-Apr;54(2):207-9. doi: 10.1097/MAT.0b013e3181648dbc. PMID: 18356657.
• 18. Gerritsen WB, vanBoven WJ, Wesselink RM, Smelt M, Morshuis WJ, vanDongen HP, et al. Significant reduction in blood loss in patients undergoing minimal extracorporea lcirculation. Transfusion medicine 2006;16:329-34.
• 19. Cremer J, Martin M, Redl H, Bahrami S, Abraham C, Graeter T, et al. Systemic inflammatory response syndrome after cardiac operations. Ann Thorac Surg. 1996 Jun;61(6):1714-20. doi: 10.1016/0003-4975(96)00055-0. PMID: 8651772.
• 20. Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? J Thorac Cardiovasc Surg. 2003 Jun;125(6):1438-50. doi: 10.1016/s0022-5223(02)73291-1. PMID: 12830066.
• 21. Fang WC, Helm RE, Krieger KH, Rosengart TK, DuBois WJ, Sason C, et al. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation. 1997 Nov 4;96(9 Suppl):II-194-9. PMID: 9386097.
• 22. Remadi J, Rakotoarivello Z, Marticho P, Trojette F, Benamar A, Poulain H, et al. Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versusst and ard cardiopulmonary bypass: a randomized prospective trial. The Journal of thoracic and cardiovascular surgery. 2004;128(3); 436-41.
• 23. Remadi JP, Rakotoarivelo Z, Marticho P, Benamar A. Prospective randomized study comparing coronary artery bypass grafting with the new mini- extracorporeal circulation Jostra System or with a standard cardiopulmonary bypass Am Heart J. 2006 Jan;151(1):198. doi: 10.1016/j.ahj.2005.03.067. PMID: 16368318.
• 24. Liebold A, Wiesenack C, Prasser C, Philipp A, Jagiello M, Birnbaum D. Standardor mini-CPB? Impact on organ perfusion. The Thoracic and Cardiovascular Surgeon. 2004; 52;1-62.
• 25. Immer FF, Ackermann A, Gygax E, Stalder M, Englberger L, Eckstein FS, et al. Minimal extracorporeal circulation is a promising technique for coronary artery bypass grafting. TheAnnals of thoracicsurgery. 2007;84(5); 1515-21.
• 26. Ersoy O. Karaciğer Enzim Yüksekliğinin Değerlendirilmesi Ankara Medical Journal 2012; 12(3):129-135.
• 27. Wiesenack C, Liebold A, Philipp A, Ritzka M, Koppenberg J, Birnbaum DE, et al. Four years' experience with a miniaturized extracorporeal circulation system and its influence on clinical outcome. Artif Organs. 2004 Dec;28(12):1082-8. doi: 10.1111/j.1525-1594.2004.00030.x. PMID: 15554936.
• 28. Badak TO, İşkesen Aİ. Koroner Arter Cerrahisinin Solunum Fonksiyonlarına Etkilerinin Solunum Fonksiyon Testi ile Değerlendirilmesi. CBU-SBED, 2021, 8(2): 331-336.