Araştırma Makalesi
BibTex RIS Kaynak Göster

İzole Koroner Arter Baypas Operasyonu Sonrasında Ciddi Plevral Efüzyon Gelişen Hastaların Değerlendirilmesi

Yıl 2022, Cilt: 32 Sayı: 4, 455 - 458, 31.08.2022
https://doi.org/10.54005/geneltip.1134123

Öz

Amaç: Yapmış olduğumuz bu çalışmada, izole koroner baypas operasyonu yapılan ve erken postoperatif dönemde ciddi plevral efüzyon gelişen hastalarda, preoperatif ve operatif faktörlerin postoperatif plevral efüzyon ile ilişkisinin belirlenmesi amaçlandı.
Yöntemler: Bu çalışmamızda, Şubat 2001 ile Temmuz 2013 tarihleri arasındaki çalıştığımız kliniklerdeki opere edilen 7862 izole koroner arter bypass cerrahisi olgusu retrospektif olarak incelendi.
Bulgular: Çalışmaya dahil edilen hastalardan 175 (%2.2) olguda erken-ciddi plevral efüzyon gelişti. Bu olguların yaş ortalaması 66.3±9.5 (55-76) idi. Olguların 149 (%85.1)’u elektif şartlarda, 26 (%14.9)’sı ise acil şartlarda operasyona alındı. Olguların ortalama kardiyopulmoner bypass zamanı, 70±28 (40-100) dakikaydı. Olgulardan 161 (%92)‘inde sol internal torasik arter (LİTA) ve safen ven greft (SVG) birlikte kullanıldı. Olguların 126 (%72)’sı nefes darlığı, 115 (%65.7)’si kuru öksürük, 28 (%16)’i prodüktif öksürük, 50 (%28.6)’si takipne, 22 (%12.5)’i ise göğüs ağrısı şikayeti ile tekrar başvurdu. Olguların 154 (%88)’ünde sol hemitoraksta erken ciddi plevral efüzyon gelişti. Bu olguların 148 (%84.6)’inde LİTA+SVG, 6 (%3.4)’sında ise sadece SVG kullanıldı. Olguların 14 (%8)’ünde sağ hemitoraksta erken ciddi plevral efüzyon gelişti. Bu olguların ise 10 (%5.7)’unda LİTA+SVG, 4 (%2.3)’ünde ise sadece SVG kullanıldı. Bilateral erken ciddi plevral efüzyon gelişen olgular ise 7 (%4) idi. Bu olguların 3 (%1.7)’ünde LİTA+SVG, 4 (%2.3)’ünde ise sadece SVG kullanıldı.
Sonuç: Koroner arter bypass cerrahisinin postoperatif pulmoner fonksiyonun bozulmasına neden olduğu bilinmektedir. Koroner arter bypass cerrahisinin en sık görülen komplikasyonlarından biri de plevral efüzyondur. Postoperatif oluşan bu tablonun hastanede kalış süresinin artması ve operasyon sonrası yüksek morbidite ile ilişkili olduğu bilinmektedir. Postoperatif hasta yönetimi ve morbidite değerlendirilmesi açısından preoperatif risklerin belirlenmesi önem arz etmektedir.

Destekleyen Kurum

Destekleyen kurum bulunmamaktadır.

Kaynakça

  • 1. Sadikot RT, Rogers JT, Cheng DS, et al. Pleural fluid characteristics of patients with symptomatic pleural effusion after coronary artery bypass graft surgery. Arch Intern Med. 2000;160:2665-8.
  • 2. Light RW, Rogers JT, Moyers JP, et al. Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery. Am J Respir Crit Care Med. 2002;166:1567-71.
  • 3. Hurlbut D, Myers ML, Lefcoe M, Goldbach M. Pleuropulmonary morbidity: internal thoracic artery versus saphenous vein graft. Ann Thorac Surg. 1990;50:959-64.
  • 4. Shawon MSR, Odutola M, Falster MO, Jorm LR. Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis. J Cardiothorac Surg. 2021;16:172.
  • 5. Karolyi M, Eberhard M, Gloor T, et al. Routine early postoperative computed tomography angiography after coronary artery bypass surgery: clinical value and management implications. Eur J Cardiothorac Surg. 2021.
  • 6. Peng MC, Hou CJ, Li JY, Hu PY, Chen CY. Prevalence of symptomatic large pleural effusions first diagnosed more than 30 days after coronary artery bypass graft surgery. Respirology. 2007;12:122-6.
  • 7. Merin O, Maher D, Silberman S, et al. [Pleural effusion following coronary bypass surgery]. Harefuah. 2007;146:826-8, 912.
  • 8. Allen BS, Buckberg GD, Rosenkranz ER, et al. Topical cardiac hypothermia in patients with coronary disease. An unnecessary adjunct to cardioplegic protection and cause of pulmonary morbidity. J Thorac Cardiovasc Surg. 1992;104:626-31.
  • 9. Rezk ME, Elgazzar MA, Abo Youssef SM, et al. Open Versus Closed Pleura Internal Mammary Artery Harvesting and Early Pulmonary Function After Coronary Artery Bypass Grafting. Heart Lung Circ. 2020;29:1412-7.
  • 10. Staton GW, Williams WH, Mahoney EM, et al. Pulmonary outcomes of off-pump vs on-pump coronary artery bypass surgery in a randomized trial. Chest. 2005;127:892-901.

Evaluation of the Patients Developing Severe Pleural Effusion After Isolated Coronary Artery Bypass Operation

Yıl 2022, Cilt: 32 Sayı: 4, 455 - 458, 31.08.2022
https://doi.org/10.54005/geneltip.1134123

Öz

Objective: In this study, we aim to determine the causal relationship between isolated coronary bypass surgery development of severe pleural effusion in the early postoperative period.
Methods: In this study, 7862 isolated coronary artery bypass surgery cases conducted in our hospital between February 2001 and July 2013 were analyzed retrospectively.
Results: Early-severe pleural effusion developed in 175 (2.2%) patients included in the study. The mean age of these cases was 66.3±9.5 (55-76). 149 (85.1%) of the cases were operated under elective conditions and 26 (14.9%) of them were operated under emergency conditions. The mean cardiopulmonary bypass time of the cases was 70±28 (40-100) minutes. Left internal thoracic artery (LITA) and saphenous vein graft (SVG) were used together in 161 (92%) cases. Of the cases, 126 (72%) had shortness of breath, 115 (65.7%) dry cough, 28 (16%) productive cough, 50 (28.6%) tachypnea, 22 (12.5%) chest pain. Early severe pleural effusion developed in the left hemithorax in 154 (88%) of the cases. LITA+SVG was used in 148 (84.6%) of these cases, and only SVG was used in 6 (3.4%) cases. Early severe pleural effusion developed in the right hemithorax in 14 (8%) of the cases. LITA+SVG was used in 10 (5.7%) of these cases, and only SVG was used in 4 (2.3%) cases. The cases with bilateral early severe pleural effusion were 7 (4%). LITA+SVG was used in 3 (1.7%) of these cases, and only SVG was used in 4 (2.3%) cases.
Conclusion: It is known that coronary artery bypass surgery causes deterioration of postoperative pulmonary function. One of the most common complications of coronary artery bypass surgery is pleural effusion. It is known that this postoperative picture is associated with increased hospital stay and high postoperative morbidity. It is important to determine preoperative risks in terms of postoperative patient management and morbidity assessment.

Kaynakça

  • 1. Sadikot RT, Rogers JT, Cheng DS, et al. Pleural fluid characteristics of patients with symptomatic pleural effusion after coronary artery bypass graft surgery. Arch Intern Med. 2000;160:2665-8.
  • 2. Light RW, Rogers JT, Moyers JP, et al. Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery. Am J Respir Crit Care Med. 2002;166:1567-71.
  • 3. Hurlbut D, Myers ML, Lefcoe M, Goldbach M. Pleuropulmonary morbidity: internal thoracic artery versus saphenous vein graft. Ann Thorac Surg. 1990;50:959-64.
  • 4. Shawon MSR, Odutola M, Falster MO, Jorm LR. Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis. J Cardiothorac Surg. 2021;16:172.
  • 5. Karolyi M, Eberhard M, Gloor T, et al. Routine early postoperative computed tomography angiography after coronary artery bypass surgery: clinical value and management implications. Eur J Cardiothorac Surg. 2021.
  • 6. Peng MC, Hou CJ, Li JY, Hu PY, Chen CY. Prevalence of symptomatic large pleural effusions first diagnosed more than 30 days after coronary artery bypass graft surgery. Respirology. 2007;12:122-6.
  • 7. Merin O, Maher D, Silberman S, et al. [Pleural effusion following coronary bypass surgery]. Harefuah. 2007;146:826-8, 912.
  • 8. Allen BS, Buckberg GD, Rosenkranz ER, et al. Topical cardiac hypothermia in patients with coronary disease. An unnecessary adjunct to cardioplegic protection and cause of pulmonary morbidity. J Thorac Cardiovasc Surg. 1992;104:626-31.
  • 9. Rezk ME, Elgazzar MA, Abo Youssef SM, et al. Open Versus Closed Pleura Internal Mammary Artery Harvesting and Early Pulmonary Function After Coronary Artery Bypass Grafting. Heart Lung Circ. 2020;29:1412-7.
  • 10. Staton GW, Williams WH, Mahoney EM, et al. Pulmonary outcomes of off-pump vs on-pump coronary artery bypass surgery in a randomized trial. Chest. 2005;127:892-901.
Toplam 10 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Original Article
Yazarlar

Hakan Akbayrak 0000-0003-1637-6769

Hayrettin Tekümit 0000-0002-5157-3592

Yayımlanma Tarihi 31 Ağustos 2022
Gönderilme Tarihi 22 Haziran 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 32 Sayı: 4

Kaynak Göster

Vancouver Akbayrak H, Tekümit H. Evaluation of the Patients Developing Severe Pleural Effusion After Isolated Coronary Artery Bypass Operation. Genel Tıp Derg. 2022;32(4):455-8.