Kardiyopulmoner Bypass Eşliğinde Kalp Kapak Cerrahisi Uygulanan Hastalarda Perfüzyon Süresinin Postoperatif Sonuçlar Üzerine Etkisi
Abstract
Kardiyopulmoner bypass (KPB) eşliğinde mekanik mitral kapak veya mekanik aort kapak replasmanı operasyonları yapılmaktadır. KPB eşliğinde kalp kapak replasmanı uygulanmış hastalarda KPB/perfüzyon süresinin kardiyak cerrahi sonrası erken dönem morbidite ve mortalite ile ilişkili olduğu düşünülmektedir. Bu retrospektif çalışmada KPB eşliğinde mekanik kalp kapak replasmanı uygulanmış hastaların KPB/perfüzyon süresinin erken dönem postoperatif sonuçlar üzerine etkisinin değerlendirilmesi amaçlandı.
KPB eşliğinde kalp kapak cerrahisi uygulanmış, toplam 116 hasta retrospektif olarak dahil edildi. Hastaların ortalama perfüzyon süreleri hesaplandı. Ortalama perfüzyon süreleri üzerinden hastalar iki gruba ayrıldı (Ortalama perfüzyon süresinin üstünde perfüzyon süresi olanlar bir grup, ortalama sürenin altında perfüzyon süresi olanlar ikinci grup). Hastaların biyokimyasal, hematolojik ve diğer verileri gruplar arasında karşılaştırıldı.
Daha uzun perfüzyon süresine sahip grubun pacemaker, defibrilasyon ve inotrop ihtiyacı, ES transfüzyonu ve hastanede kalış süresinin daha fazla olduğu, ayrıca ALT, GGT ve pH değerleri de daha yüksekti (p<0.05). Diğer operatif, postoperatif ve erken dönem major komplikasyonlar açısından iki grubun sonuçları benzerdi (p>0.05).
Sonuç olarak daha uzun KPB/perfüzyon süresi, ilişkilendirmede nedensellik anlamına gelmese de, perfüzyon süresinin mümkün olduğunca kısa tutulması veya kabul edilebilir sınırlar içerisinde tutulması gerektiğini düşünmekteyiz.
Ethical Statement
Bu çalışma için; çalışma öncesi, çalışma yapılacak kurumdan (Şanlıurfa Mehmet Akif İnan Eğitim ve Araştırma Hastanesi) ve yerel etik kurulundan (Harran Üniversitesi Klinik Araştırmalar Etik Kurulu) onay alındı (Etik Kurul Tarihi: 28.11.2022 - Onay Numarası: HRÜ/22.23.06). Çalışma Helsinki bildirgesi prensiplerine uygun olarak yapıldı.
References
- O'Donnell A, Yutzey KE. Mechanisms of heart valve development and disease. Development. 2020;147(13):1-13.
- El Sabbagh A, Reddy YNV, Nishimura RA. Mitral Valve Regurgitation in the Contemporary Era: Insights Into Diagnosis, Management, and Future Directions. JACC Cardiovasc Imaging. 2018;11(4):628-643.
- Alkady H, Saber A, Abouramadan S, Elnaggar A, Nasr S, Mahmoud E. Mitral valve replacement in mitral stenosis; the problem of small left ventricle. J Cardiothorac Surg. 2020;15(1):67-74.
- Rajput FA, Zeltser R. Aortic Valve Replacement. Treasure Island (FL) USA: StatPearls Publishing; 2022.
- Xu S, Liu J, Li L, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study. J Cardiothorac Surg. 2019;14(1):90-101.
- Andersen LW. Lactate Elevation During and After Major Cardiac Surgery in Adults: A Review of Etiology, Prognostic Value, and Management. Anesth Analg. 2017;125(3):743-752.
- Ushio M, Egi M, Fujimoto D, Obata N, Mizobuchi S. Timing, Threshold, and Duration of Intraoperative Hypotension in Cardiac Surgery: Their Associations With Postoperative Delirium. J Cardiothorac Vasc Anesth. 2022;36(11):4062-4069.
- Madhavan S, Chan SP, Tan WC, et al. Cardiopulmonary bypass time: every minute counts. J Cardiovasc Surg (Torino). 2018;59(2):274-281.
- Wang YC, Wu HY, Luo CY, Lin TW. Cardiopulmonary Bypass Time Predicts Early Postoperative Enterobacteriaceae Bloodstream Infection. Ann Thorac Surg. 2019;107(5):1333-1341.
- Qiu Z, Chen X, Xu Y, et al. Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery?. J Cardiothorac Surg. 2018;13(1):29-36.
- Takagi H, Hari Y, Nakashima K, Kuno T, Ando T, Group A. Meta-analysis of propensity matched studies of robotic versus conventional mitral valve surgery. J Cardiol. 2020;75(2):177-181.
- Martins RS, Ukrani RD, Memon MK, Ahmad W, Akhtar S. Risk factors and outcomes of prolonged cardiopulmonary bypass time in surgery for adult congenital heart disease: a single-center study from a low-middle-income country. J Cardiovasc Surg (Torino). 2021;62(4):399-407.
- Karim HM, Yunus M, Saikia MK, Kalita JP, Mandal M. Incidence and progression of cardiac surgery-associated acute kidney injury and its relationship with bypass and cross clamp time. Ann Card Anaesth. 2017;20(1):22-27.
- Ghincea CV, Reece TB, Eldeiry M, et al. Predictors of Acute Kidney Injury Following Aortic Arch Surgery. J Surg Res. 2019;242(5):40-46.
- Axtell AL, Fiedler AG, Melnitchouk S, et al. Correlation of cardiopulmonary bypass duration with acute renal failure after cardiac surgery. J Thorac Cardiovasc Surg. 2019;159(1):170-180.
- Zhao C, Li Y, Pan G, Xu J, Liu S, Xiao Y. Risk Factors for Postoperative Acute Kidney Injury in Patients Undergoing Redo Cardiac Surgery Using Cardiopulmonary Bypass. J Cardiovasc Dev Dis. 2022;9(8):244-253.
- He Y, Zhang HS, Zhang TZ, Feng Y, Zhu Y, Fan X. Analysis of the risk factors for severe lung injury after radical surgery for tetralogy of fallot. Front Surg. 2022;9(1):1-9.
- Andrási TB, Talipov I, Dinges G, Arndt C, Rastan AJ. Risk factors for postoperative delirium after cardiac surgical procedures with cardioplegic arrest. Eur J Cardiothorac Surg. 2022;62(1):570-579.
- Jia H, Huang B, Kang L, et al. Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation. EClinicalMedicine. 2022;47(5):1-9.
- Ahmad J, Khan OS, Russell SS, Ahmed R, Hoque R. Effect of Cardiopulmonary Bypass on Blood and Coagulation Profile in Patients Undergoing Cardiac Surgery. Mymensingh Med J. 2022;31(2):477-483.
- Alotaibi RK, Saleem AS, Alsharef FF, et al. Risk factors of early postoperative cardiac arrhythmia after pediatric cardiac surgery: A single-center experience. Saudi Med J. 2022;43(10):1111-1119.
- Swinkels BM, Ten Berg JM, Kelder JC, Vermeulen FE, Van Boven WJ, de Mol BA. Effect of aortic cross-clamp time on late survival after isolated aortic valve replacement. Interact Cardiovasc Thorac Surg. 2021;32(2):222-228.
- Salsano A, Giacobbe DR, Sportelli E, et al. Aortic cross-clamp time and cardiopulmonary bypass time: prognostic implications in patients operated on for infective endocarditis. Interact Cardiovasc Thorac Surg. 2018;27(3):328-335.
- Robich M, Ryzhov S, Kacer D, et al. Prolonged Cardiopulmonary Bypass is Associated With Endothelial Glycocalyx Degradation. J Surg Res. 2020;251:287-295.
- Bangalore H, Carter MJ, Parmar K, et al. Degradation of the Endothelial Glycocalyx Contributes to Metabolic Acidosis in Children Following Cardiopulmonary Bypass Surgery. Pediatr Crit Care Med. 2021;22(11):e571-e581.
- Nadeem R, Agarwal S, Jawed S, Yasser A, Altahmody K. Impact of Cardiopulmonary Bypass Time on Postoperative Duration of Mechanical Ventilation in Patients Undergoing Cardiovascular Surgeries: A Systemic Review and Regression of Metadata. Cureus. 2019;11(11):1-7.
- Mehmood A, Nadeem RN, Kabbani MS, et al. Impact of Cardiopulmonary Bypass and Aorta Cross Clamp Time on the Length of Mechanical Ventilation after Cardiac Surgery among Children: A Saudi Arabian Experience. Cureus. 2019;11(8):1-9.
The Effect Of Perfusion Time On Postoperative Results In Patients Undergoing Cardiopulmonary Bypass Accompanied Heart Valve Surgery
Abstract
Mechanical mitral valve or mechanical aortic valve replacement operations are performed with cardiopulmonary bypass (CPB). CPB/perfusion time is thought to be associated with early morbidity and mortality after cardiac surgery in patients who underwent CPB-guided heart valve replacement. In this retrospective study, it was aimed to evaluate the effect of CPB/perfusion time on early postoperative outcomes in patients who underwent CPB-guided mechanical heart valve replacement.
A total of 116 patients who underwent CPB-guided heart valve surgery were included retrospectively. The mean perfusion times of the patients were calculated. The patients were divided into two groups based on the mean perfusion times (one group with a perfusion time above the mean perfusion time, the second group with a perfusion time below the mean perfusion time). Biochemical, hematological and other data of the patients were compared between the groups.
The group with longer perfusion time had higher need for pacemaker, defibrillation and inotrope, ES transfusion and hospital stay, and also had higher ALT, GGT and pH values (p<0.05). The results of the two groups were similar in terms of other operative, postoperative and early period major complications (p>0.05).
As a result, although longer CPB/perfusion time does not mean causality in the association, we think that the perfusion time should be kept as short as possible or within acceptable limits.
References
- O'Donnell A, Yutzey KE. Mechanisms of heart valve development and disease. Development. 2020;147(13):1-13.
- El Sabbagh A, Reddy YNV, Nishimura RA. Mitral Valve Regurgitation in the Contemporary Era: Insights Into Diagnosis, Management, and Future Directions. JACC Cardiovasc Imaging. 2018;11(4):628-643.
- Alkady H, Saber A, Abouramadan S, Elnaggar A, Nasr S, Mahmoud E. Mitral valve replacement in mitral stenosis; the problem of small left ventricle. J Cardiothorac Surg. 2020;15(1):67-74.
- Rajput FA, Zeltser R. Aortic Valve Replacement. Treasure Island (FL) USA: StatPearls Publishing; 2022.
- Xu S, Liu J, Li L, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study. J Cardiothorac Surg. 2019;14(1):90-101.
- Andersen LW. Lactate Elevation During and After Major Cardiac Surgery in Adults: A Review of Etiology, Prognostic Value, and Management. Anesth Analg. 2017;125(3):743-752.
- Ushio M, Egi M, Fujimoto D, Obata N, Mizobuchi S. Timing, Threshold, and Duration of Intraoperative Hypotension in Cardiac Surgery: Their Associations With Postoperative Delirium. J Cardiothorac Vasc Anesth. 2022;36(11):4062-4069.
- Madhavan S, Chan SP, Tan WC, et al. Cardiopulmonary bypass time: every minute counts. J Cardiovasc Surg (Torino). 2018;59(2):274-281.
- Wang YC, Wu HY, Luo CY, Lin TW. Cardiopulmonary Bypass Time Predicts Early Postoperative Enterobacteriaceae Bloodstream Infection. Ann Thorac Surg. 2019;107(5):1333-1341.
- Qiu Z, Chen X, Xu Y, et al. Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery?. J Cardiothorac Surg. 2018;13(1):29-36.
- Takagi H, Hari Y, Nakashima K, Kuno T, Ando T, Group A. Meta-analysis of propensity matched studies of robotic versus conventional mitral valve surgery. J Cardiol. 2020;75(2):177-181.
- Martins RS, Ukrani RD, Memon MK, Ahmad W, Akhtar S. Risk factors and outcomes of prolonged cardiopulmonary bypass time in surgery for adult congenital heart disease: a single-center study from a low-middle-income country. J Cardiovasc Surg (Torino). 2021;62(4):399-407.
- Karim HM, Yunus M, Saikia MK, Kalita JP, Mandal M. Incidence and progression of cardiac surgery-associated acute kidney injury and its relationship with bypass and cross clamp time. Ann Card Anaesth. 2017;20(1):22-27.
- Ghincea CV, Reece TB, Eldeiry M, et al. Predictors of Acute Kidney Injury Following Aortic Arch Surgery. J Surg Res. 2019;242(5):40-46.
- Axtell AL, Fiedler AG, Melnitchouk S, et al. Correlation of cardiopulmonary bypass duration with acute renal failure after cardiac surgery. J Thorac Cardiovasc Surg. 2019;159(1):170-180.
- Zhao C, Li Y, Pan G, Xu J, Liu S, Xiao Y. Risk Factors for Postoperative Acute Kidney Injury in Patients Undergoing Redo Cardiac Surgery Using Cardiopulmonary Bypass. J Cardiovasc Dev Dis. 2022;9(8):244-253.
- He Y, Zhang HS, Zhang TZ, Feng Y, Zhu Y, Fan X. Analysis of the risk factors for severe lung injury after radical surgery for tetralogy of fallot. Front Surg. 2022;9(1):1-9.
- Andrási TB, Talipov I, Dinges G, Arndt C, Rastan AJ. Risk factors for postoperative delirium after cardiac surgical procedures with cardioplegic arrest. Eur J Cardiothorac Surg. 2022;62(1):570-579.
- Jia H, Huang B, Kang L, et al. Preoperative and intraoperative risk factors of postoperative stroke in total aortic arch replacement and stent elephant trunk implantation. EClinicalMedicine. 2022;47(5):1-9.
- Ahmad J, Khan OS, Russell SS, Ahmed R, Hoque R. Effect of Cardiopulmonary Bypass on Blood and Coagulation Profile in Patients Undergoing Cardiac Surgery. Mymensingh Med J. 2022;31(2):477-483.
- Alotaibi RK, Saleem AS, Alsharef FF, et al. Risk factors of early postoperative cardiac arrhythmia after pediatric cardiac surgery: A single-center experience. Saudi Med J. 2022;43(10):1111-1119.
- Swinkels BM, Ten Berg JM, Kelder JC, Vermeulen FE, Van Boven WJ, de Mol BA. Effect of aortic cross-clamp time on late survival after isolated aortic valve replacement. Interact Cardiovasc Thorac Surg. 2021;32(2):222-228.
- Salsano A, Giacobbe DR, Sportelli E, et al. Aortic cross-clamp time and cardiopulmonary bypass time: prognostic implications in patients operated on for infective endocarditis. Interact Cardiovasc Thorac Surg. 2018;27(3):328-335.
- Robich M, Ryzhov S, Kacer D, et al. Prolonged Cardiopulmonary Bypass is Associated With Endothelial Glycocalyx Degradation. J Surg Res. 2020;251:287-295.
- Bangalore H, Carter MJ, Parmar K, et al. Degradation of the Endothelial Glycocalyx Contributes to Metabolic Acidosis in Children Following Cardiopulmonary Bypass Surgery. Pediatr Crit Care Med. 2021;22(11):e571-e581.
- Nadeem R, Agarwal S, Jawed S, Yasser A, Altahmody K. Impact of Cardiopulmonary Bypass Time on Postoperative Duration of Mechanical Ventilation in Patients Undergoing Cardiovascular Surgeries: A Systemic Review and Regression of Metadata. Cureus. 2019;11(11):1-7.
- Mehmood A, Nadeem RN, Kabbani MS, et al. Impact of Cardiopulmonary Bypass and Aorta Cross Clamp Time on the Length of Mechanical Ventilation after Cardiac Surgery among Children: A Saudi Arabian Experience. Cureus. 2019;11(8):1-9.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | Araştırma Makaleleri |
| Authors | |
| Early Pub Date | December 30, 2023 |
| Publication Date | December 31, 2023 |
| Submission Date | October 24, 2023 |
| Acceptance Date | November 15, 2023 |
| Published in Issue | Year 2023 Volume: 4 Issue: 2 |
