KORONER ARTER BYPASS CERRAHİSİ SONRASI MAJOR ADVERS OLAYA ETKİ EDEN FAKTÖRLER

Yıl 2024, , 221 - 226, 29.04.2024

Hüsnü Kamil Limandal , Taha Özkara

https://doi.org/10.18229/kocatepetip.1315953

Öz

AMAÇ: Çalışmamızda Koroner arter baypas greft (KABG) operasyonu geçiren hasta popülasyonumuzu mortalite ve major advers olay (MAO) gelişimi açısından incelemeyi ve MAO gelişimine etki eden faktörleri incelemeyi amaçladık.
GEREÇ VE YÖNTEM: Ocak 2017 ile Aralık 2019 tarihleri arasında KABG operasyonu olmuş 169 ardışık hasta retrospektif olarak incelenmiştir. Ölüm, miyokardiyal infarkt, reoperasyon, kardiyak tamponad, stroke, böbrek yetmezliği, sternal enfeksiyon extracorporeal membran oksijenatör ihtiyacı ve kardiyo pulmoner resüsitasyon MAO olarak tanımlandı.
BULGULAR: Hastaların yaş ortalaması 63,19 ±0,72 yıl, ortalama Kardiyopulmoner bypass (KPB) süresi 106,95 ±27 dakika, ortalama Aort Kros Klemp Süresi 44,87 ±1,05 dakika idi. 11 (%6,5) hastatya Ekstra Korporeal Membran Oksijenatör desteği sağlandı, 7 (%4,1) hastaya reoperasyon uygulandı, 5 (%3) hastada postoperatif stroke gözlendi, 5 (%3) hastaya kardiyopulmoner resusitasyon uygulandı ve 1 (%0,6) hasta postoperatif miyokardiyal enfarktüs gözlendi. Toplamda 28 (%16,6) hastada MAO gözlendi. Mortalite 9 (%5,3) hastada gözlendi. Univaryant analizde Euroskor, KPB sırasındaki ortalama arteryel basınç ve ultrafiltrasyon volümünün MAO ile ilişkili olduğu gözlendi (sırası ile p=0,004, p=0,026 ve p=0,037). Ancak multivaryant analizde sadece Euroskor (oddsratio: 1,453, %95 CI 1,166-1,811 p=0,001) ve ultrafiltrasyon volümü (oddsratio:-0,002, %95 CI 0,996-1 p=0,04) MAO ile ilişkili bulundu.
SONUÇ: Çalışmamızda yüksek Euroskor düzeylerinin sadece mortaliteyi değil aynı zamanda MAO insidansını da arttırdığı ve artmış ultrafiltrasyon volümlerinin MAO insidansını azalttığını gözlemledik. Uygun ultrafiltrasyon ve KPB stratejisinin MAO insidansını azaltabileceği KABG cerrahisi sırasında akılda bulundurulması gerektiği kanaatindeyiz.

Anahtar Kelimeler

Majoradvers olay, Mortalite, Morbidite, Koroner arter bypass greftleme.

FACTORS AFFECTING MAJOR ADVERSE EFFECTS AFTER CORONARY ARTERY BYPASS SURGERY

Öz

OBJECTIVE: The present study aimed to evaluate the patient population who underwent coronary artery bypass grafting (CABG) operation in terms of mortality and major adverse effects (MAE) incidence and examine the factors affecting MAE incidence.
MATERIAL AND METHODS: 169 consecutive patients who underwent CABG surgery between January 2017 and December 2019 were retrospectively analyzed. Mortality, myocardial infarction, reoperation, cardiac tamponade, stroke, renal failure, sternal infection, need for extracorporeal membrane oxygenator and cardio pulmonary resuscitation were defined as MAO.
RESULTS: The mean age of the patients was 63.19 ±0.72 years, the mean duration of cardiopulmonary bypass (CPB) was 106.95 ±27 minutes, and the mean duration of aortic cross-clamp was 44.87 ±1.05 minutes. Extracorporeal membrane oxygenator support was provided to 11 (6.5%) patients, 7 (4.1%) patients underwent reoperation, 5 (3%) patients experienced a postoperative stroke, 5 (3%) patients required cardiopulmonary resuscitation, and postoperative myocardial infarction was observed in 1 (0.6%) patient. In total, MAE was determined in 28 (16.6%) patients. Mortality occurred in 9 (5.3%) patients. In the univariate analysis, Euroscore, mean arterial pressure during CPB, and ultrafiltration volume were associated with MAE (p=0.004, p=0.026, and p=0.037, respectively). However, in multivariate analysis, only Euroscore (odds ratio: 1.453, 95% CI 1.166-1.811 p=0.001) and ultrafiltration volume (odds ratio:-0.002, 95% CI 0.996-1 p=0.04) were correlated to MAE.
CONCLUSIONS: In our study, we observed that high Euroscore levels increased not only mortality but also the incidence of MAO, and increased ultrafiltration volumes reduced the incidence of MAO. We believe that it should be kept in mind during CABG surgery that appropriate ultrafiltration and CPB strategy can reduce the incidence of MAO.

Anahtar Kelimeler

Major adverse effects, Mortality, Morbidity, Coronary artery bypass grafting

Kaynakça

• 1. Serruys PW, Morice M-C, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961-972.
• 2. Shahian DM, O'Brien SM, Filardo G, et al. Society of Thoracic Surgeons Quality Measurement Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1-coronary artery bypass grafting surgery. Ann Thorac Surg. 2009;88(1): S2-22.
• 3. Farkouh ME, Domanski M, Sleeper LA. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367:2375-84.
• 4. Kamel ATH, Hassouna A, El-Hamid H, et al. Major adverse cardiac events after first time elective isolated coronary artery bypass grafting: A retrospective cohort study. Journal of the Egyptian Society of Cardio- Thoracic Surgery. 2018;26: 237-244.
• 5. Nashef SAM, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). European Journal of Cardio-thoracic Surgery.1999;16: 9-13.
• 6. Rushing GD, Yuh DD. Primary Coronary Artery Bypass Surgery. In: Yuh DD, Vricella LA, Yang SC, Doty JR (eds). Johns Hopkins Textbook of Cardiothoracic Surgery, 2nd edition. McGraw-Hill Education, New York. 2014: 414-32.
• 7. Antunes PE, de Oliveira JF, Antunes MJ. Risk-prediction for postoperative major morbidity in coronary surgery. Eur J Cardiothorac Surg. 2009;35:760-8.
• 8. Rocha AS, Pittella FJ, Lorenzo AR, et al. Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc. 2012; 27:45-51.
• 9. Rao V, Ivanov J, Weisel RD, et al. Predictors of low cardiac output syndrome after coronary artery bypass. J ThoracCardiovasc Surg. 1996;112(1):38-51.
• 10. Safaie N, Montazerghaem H, Jodati A, et al. In-hospital complications of coronary artery bypass graft surgery in patients older than 70 years. J CardiovascThorac Res. 2015;7:60-2.
• 11. Barbir M, Lazem F, Ilsley C, et al. Coronary artery surgery in women compared with men: analysis of coronary risk factors and in-hospital mortality in a single centre. Br Heart J. 1994;71(5):408-12.
• 12. Utley JR, Wilde EF, Leyland SA, et al. Intraoperative blood transfusion is a major risk factor for coronary artery bypass grafting in women. Ann Thorac Surg.1995;60:570-5.
• 13. Loberman D, Consalvi C, Healey A, et al. Adverse Cerebral Outcomes after Coronary Artery Bypass Surgery-More Than a Decade of Experience in a Single Center. ThoracCardiovasc Surg. 2018;66(6):452-6.
• 14. Alam M, Bandeali SJ, Kayani WT, et al. Comparison by meta-analysis of mortality after isolated coronary artery bypass grafting in women versus men. Am J Cardiol. 2013; 112: 309-317.
• 15. Ergunes K, Yilik L, Yetkin U, et al. Early and mid-term outcomes in female patients undergoing isolated conventional coronary surgery. J CardiovascThorac Res. 2014;6:105-110.
• 16. Terada T, Johnson JA, Norris C, et al. Severe Obesity Is Associated With Increased Risk of Early Complications and Extended Length of Stay Following Coronary ArteryBypass Grafting Surgery. J AmHeartAssoc. 2016;5(6):3282.
• 17. Aronson S, Boisvert D, Lapp W. Isolated systolic hypertension is associated with adverse outcomes from coronary artery bypass grafting surgery. Anesth Analg. 2002;94:1079-84.
• 18. Ho CH, Chen YC, Chu CC, et al. Postoperative complications after coronary artery bypass grafting in patients with chronic obstructive pulmonary disease. Medicine (Baltimore). 2016;95:2926.
• 19. Bingol H, Cingoz F, Balkan A, et al. The effect of oral prednisolone with chronic obstructive pulmonary disease undergoing coronary artery bypass surgery. J CardSurg. 2005;20:252-6.
• 20. Munnee K, Bundhun PK, Quan H, et al. Comparing the clinical outcomes between insulin-treated and non-insulin-treated patients with type 2 diabetes mellitus after coronary artery bypass surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2016;95:3006.
• 21. Wang TK, Woodhead A, Ramanathan T, Pemberton J. Relationship between diabetic variables and outcomes after coronary artery bypass grafting in diabetic patients. Heart Lung Circ. 2017;26:371-5.
• 22. Liu H, Yan X, Yu J. Long noncoding RNA NEAT1/microRNA-125a axis predicts increased major adverse cardiac and cerebrovascular event risk independently in patients with unprotected left main coronary artery disease underwent coronary artery bypass grafting. J Clin Lab Anal. 2020;34(7):e23299.
• 23. Nakatsu T, Tamura N, Yanagi S, et al. Bilateral internal thoracic artery grafting for peripheral arterial disease patients. Gen Thorac Cardiovasc Surg. 2014;62:481-7.
• 24. Forbes TL, Ricco JB. Trans-Atlantic debate: is carotid artery disease responsible for perioperative strokes after coronary artery bypass surgery. Eur J Vasc Endovasc Surg. 2010;40:689-695.
• 25. Roffi M, Ribichini F, Castriota F, et al. Management of combined severe carotid and coronary artery disease. Curr Cardiol Rep. 2012;14:125-34.
• 26. Anyanwu AC, Filsoufi F, Salzberg SP, et al. Epidemiology of stroke after cardiac surgery in the currentera. J Thorac Cardiovasc Surg. 2007;134:1121-7.
• 27. Bottle A, Mozid A, Grocott HP, et al. Preoperative stroke and outcomes after coronary artery bypass graft surgery. Anesthesiol. 2013;118: 885-93.
• 28. Nichols EL, McCullough JN, Ross CS, et al. Optimal timing from myocardial infarction to coronary artery bypass grafting on hospital mortality. Ann Thorac Surg. 2017;103:162-71.
• 29. Jarvinen O, Hokkanen M, Huhtala H. The long-term effect of perioperative myocardial infarction on health-related quality-of-life after coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2014;18:568-573.
• 30. Simchen E, Galai N, Zitser-Gurevich Y, et al. Sequential logistic models for 30 days mortality after CABG: pre-operative, intra-operative and post-operative experience e the Israeli CABG study (ISCAB). Eur J Epidemiol. 2000;16(6):543-55.
• 31. Salehi M, Bakhshandeh A, Rahmanian M et al. Coronary artery bypass grafting in patients with advanced left ventricular dysfunction: Excellent early outcome with improved ejection fraction. J Tehran Heart Cent. 2016;11:6-10.
• 32. Kamal YA, Al-Elwany SM, Ghoneim AF, et al. Predictors of adverse effects after coronary artery bypass grafting in patients with reduced left ventricular ejection fraction. J Egypt SocCardiothorac Surg. 2017;25:20-7.
• 33. Hamad MA, van Straten AH, Schonberger JP, et al. Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population. J Cardiothorac Surg. 2010;5:29.
• 34. Bianco V, Kilic A, Aranda-Michel E, et al. Complete revascularization during coronary artery bypass grafting is associated with reduced major adverse events. J ThoracCardiovasc Surg. 2021; 9(22)-151-3.
• 35. Boodhwani M, Williams K, Babaev A, et al. Ultrafiltration reduces blood transfusions following cardiac surgery: A meta-analysis. Eur J Cardiothorac Surg. 2006;30: 892-7.
• 36. Tassani P, Richter JA, Barankay A, et al. Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures? J Cardiothorac VascAnesth. 199;13:165-72.
• 37. Weber CF, Jámbor C, StrasserC,et al. Normovolemic modified ultrafiltration is associated with beter preserved platelet function and less postoperative blood loss in patients undergoing complex cardiac surgery: a randomized and controlled study. J ThoracCardiovasc Surg. 2011;141:1298-1304.