Kombine koroner arter bypass greft ve kapak ameliyatlarında risk faktörleri ; The risk factors of combined valve replacement and coronary artery bypass grafting

Koroner arter hastalığı ile kapak hastalığının bir arada bulunduğu hastalarda gerçekleştirilen ameliyatların mortalite ve morbiditesi daha yüksektir. Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Merkezinde Ocak 1994 - Mayıs 1998 tarihleri arasında yapılan 49 kombine koroner ve kapak operasyonu preoperatif, operatif ve postoperatif özellikler açısından incelendi. Sonuçlara etki eden risk faktörleri saptanmaya çalışıldı. Hastaların ortalama yaşı 64,2 idi. 35( % 71)i erkekti.Olguların 29'unda (.1) aort kapak lezyonu, 19'unda mitral kapak lezyonu ve l olguda aort ve mitral kapak lezyonu koroner arter hastalığına eşlik ediyordu. 2 olguda ciddi triküspid yetersizliği vardı. Olguların 29'unda aort kapak replasmanı, 14'ünde mitral kapak replasmanı, 1’inde aort ve mitral kapak replasmanı, 2'sinde mitral kapak replasmanı ve triküspid De Vega annüloplasti ve 3'ünde mitral ring annüloplasti koroner arter bypass ameliyatı ile birlikte uygulandı. Aort kapak replasmanı uygulanan olgulardan birinde Benthall operasyonu, bir diğerinde ise asandan aortaya tüp greft ile replasman yapıldı. Kullanılan protezler 43 mekanik, 3 bioprotez, 3 fleksibl mitral ring idi. Yapılan ortalama distal anastomoz sayısı 1.8 idi. Kan kardioplejisi uygulanan 2 olgu dışında hastaların tümünde 28 C sistemik hipotermi, antegrad soğuk kritaloid kardiopleji ve topikal hipotermi ile kardiak arrest ve miyokard koruması sağlandı. Ortalama kros klemp süresi 72 dk., bypass süresi ise 94 dk.idi. Perioperatif mortalite %8.16 (4 olgu) idi. Ölüm nedenleri olguların 2 sinde düşük kardiyak debi. 1’inde enfeksiyon, 1’inde ise postoperarif inferior akut myokard infarktüsü idi. Risk faktörleri,mitral yetmezliği, NYHA Klas IV, bayan cinsiyet ve kros klemp süresinin uzun olması olarak saptandı. ; We know that when coronary artery disease accom- panies with the valvular heart disease, the mortality and morbidity rate increase. In this study we exam- ined 49 patients with CAD and valvular heart dis- ease together according to their preoperative, opera- tive and postoperative characteristics, between January 1994 and May 1998 at Dr. Siyami Ersek Hos- pital. We tried to find out the risk factors that affect the results of the operations. The mean age of patients was 64.2, and 35 of them were male ().There were aortic valvular lesions in 29 cases(.1), mitral valve. lesions in 19, and aor- tic and mitral valve lesions together in l case. In 2 cases there were serious tricuspid insufficiency, ei- ther. In all cases we had CAD accompanying these lesions. Besides CABG operations, in 29 cases we performed aortic valvular replacements, in 14 cases mitral val- vular replacements, in l case aortic and mitral valves replacement in 2 cases we performed Tricuspid De Vega annuloplasty accompanying to mitral valve re- placement. Finally in 3 cases we performed mitral ring annuloplasty accompanying to CABG opera- tions. In l of the patients that had aortic valvular re- placement, we performed Benthall operation, too. In an other patient of aortic group, we replaced ascending aorta with a tube graft. Of the prosthesis we used, 43 were mechanical, 3 were bioprosthesis and 3 were flexible mitral ring. The mean number of the distal anastomosis done was 1.8. Except 2 cases that had been done under blood cardioplegia in all cases we used 28 C systemic hypother- mia, antegrad crystalloid cardioplegia ana topical hypothermia in order to accomplish the cardiac ar- rest and myocardial protection. The mean cross clamp time was 72 min. and the mean total bypass period was 91 min. The perioperative mortality rate was % 8.16 (in 4 cases). The reasons of excitus were low cardiac out- put in 2 cases, infection in l case and acute inferior myocardial infarction in l case. Finally we found out that risk factors that affect the mortality and morbidity rates were mitral valve insufficiency, being in NYHA Class IV, female sexuality and long period of cross clamp time.