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Koroner Bypass Cerrahisi Sonrası Gelişen Akut Mezenter İskemi ve Dalak Enfarktı: 32 Hastanın Analizi

Yıl 2019, Cilt: 72 Sayı: 2, 247 - 250, 02.10.2019

Çağdaş Baran

Öz

Amaç: Akut mezenter iskemi ve diğer uç organ embolileri kardiyak cerrahi sonrası hayatı tehdit eden ciddi komplikasyonlardır. Bu çalışmada, açık
kalp cerrahisi sonrası gelişen mezenter iskemi ve dalak enfarktı hastalarının sonuçlarını değerlendirdik.

Gereç ve Yöntem: Kliniğimizde Ocak 2010-Kasım 2017 yılları arasında, açık kalp cerrahisi uygulanan tüm hastalar analiz edildi ve kaydedilmiş akut
mezenter iskemi ve dalak enfarktı olan hastalar retrospektif olarak incelendi.

Bulgular: Çalışmaya 5607 hasta dahil edildi, 32 hastada (%0,57) akut mezenterik iskemi ve splenik enfarkt gözlendi. Mezenter iskemi ön tanısıyla
operasyona alınan altı hastada dalak enfarktı tespit edildi. Bu hastalarda, splenektomi sonrası semptomlar tamamen geriledi ve bütün hastalar
hayatta kaldı. Segmenter barsak rezeksiyonu sonrası yalnızca 26 hastanın ikisi sağ kaldı. Toplam mortalite 24’tü (%75). Yaş (p=0,03), diyaliz
gereksinimi (p=0,01), acil kardiyak operasyon (p=0,05), periferik arter hastalığı (p=0,001) ve yüksek risk Euroscore’ları (p=0,0001) kontrol grubuna
kıyasla anlamlı olarak farklıydı. Mezenter iskemi, çalışan kalpte yapılan koroner bypass hastalarında anlamlı olarak daha fazla gözlendi (p=0,0001).
Yine mezenter iskemi gelişen gruptaki kardiyopulmoner bypass süreleri kontrol grubuna göre anlamlı olarak daha yüksekti (p=0,0001).

Sonuç: Kardiyak cerrahi sonrası, akut mezenter iskemi hala oldukça yüksek mortalite oranlarına sahiptir. Splenik infark semptomları mezenter
iskemiyi taklit edebilir. Yüksek riskli kardiyak operasyonlarda mezenter iskemi daha sık gözlenmektedir. Erken tanı ve tedavi hayat kurtarıcı olabilir.

Anahtar Kelimeler

Mesenterik İskemi Dalak İnfarkti Kardiyak Cerrahi

Etik Beyan

Etik Kurul Onayı: Retrospektif çalışma. Hasta Onayı: Retrospektif çalışma. Hakem Değerlendirmesi: Editörler kurulunun içinden olan kişiler tarafından değerlendirilmiştir.

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

  • 1. Christenson JT, Schmuziger M, Maurice J, et al. Postoperative visceral hypotension the common cause for gastrointestinal complications after cardiac surgery. Thorac Cardiovasc Surg. 1994;42:152-157.
  • 2. Zacharias A, Schwann TA, Parenteau GL, et al. Predictors of gastrointestinal complications in cardiac surgery. Tex Heart Inst J. 2000;27:93-99.
  • 3. Mangi AA, Christison-Lagay ER, Torchiana DF, et al. Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients. Ann Surg. 2005;241:895-901.
  • 4. Bolcal C, Iyem H, Sargin M, et al. Gastrointestinal complications after cardiopulmonary bypass: sixteen years of experience. Can J Gastroenterol. 2005;19:613-617.
  • 5. Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann Surg. 2007;246:323- 329.
  • 6. Acosta-Merida MA, Marchena-Gomez J, Hemmersbach-Miller M, et al. Identification of risk factors for perioperative mortality in acute mesenteric ischemia. World J Surg. 2006;30:1579-1585.
  • 7. Schoots IG, Koffeman GI, Legemate DA, et al. Systematic review of survival after acutemesenteric ischaemia according to disease aetiology. Br J Surg. 2004;91:17-27.
  • 8. Merle C, Lepouse C, de Garine A, et al. Surgery for mesenteric infarction: prognostic factors associated with early death within 72 hours. J Cardiothorac Vasc Anesth. 2004;18:734-741.
  • 9. Park WM, Gloviczki P, Cherry Jr K.J, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg. 2002;35:445-452.
  • 10. Chaudhuri N, James J, Sheikh A, et al. Intestinal ischaemia following cardiac surgery: a multivariate risk model. Eur J Cardiothorac Surg. 2006;29:971- 977.
  • 11. Garofalo M, Borioni R, Nardi P, et al. Early diagnosis of acute mesenteric ischemia after cardiopulmonary bypass. J Cardiovasc Surg (Torino). 2002;43:455-459.
  • 12. Yasuhara H. Acute mesenteric ischemia: the challenge of gastroenterology. Surg Today. 2005;35:185-195.
  • 13. Blauth CI, Cosgrove DM, Webb BW, et al. Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg. 1992;103:1104-1111.
  • 14. Cernilia J, Godbe DH, Ott R, et al. Splenic infarction from cholesterol embolization following cardiopulmonary bypass. Cardiovasc Surg. 1995;3:607-610.
  • 15. Woo K, Major K, Kohanzadeh S, et al. Laparotomy for visceral ischemia and gangrene. Am Surg. 2007;73:1006-1008.
  • 16. Hamada T, Yamauchi M, Tanaka M, et al. Prospective evaluation of contrastenhanced ultrasonography with advanced dynamic flow for the diagnosis of intestinal ischaemia. Br J Radiol. 2007;80:603-608.
  • 17. Ofer A, Abadi S, Nitecki S, et al. Multidetector CT angiography in the evaluation of acute mesenteric ischemia. Eur Radiol. 2009;19:24-30.

Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients

Yıl 2019, Cilt: 72 Sayı: 2, 247 - 250, 02.10.2019

Çağdaş Baran

Öz

Objectives: Acute mesenteric ischemia and other end organ emboli are serious life-threatening complications after open-heart surgery. In this
study, we evaluated the outcome of patients with mesenteric ischemia and splenic infarction after cardiac surgery.

Materials and Methods: From January 2010 to November 2017, all patients (5607) who underwent open-heart surgery were analysed, and patients
with registered acute mesenteric ischemia and splenic infarct (32) were retrospectively reviewed.

Results: Five thousand six hundred and seven patients were included in this study, of which 32 (0.57%) patients suffered from acute mesenteric
ischemia and splenic infarct. Intraoperatively, splenic infarction was detected in six patients who were pre-diagnosed as mesenteric ischemia. In
these patients, the symptoms completely improved after the splenectomy and all the patients survived. Only two of 26 patients were survived
after segmentary bowel resection. Overall mortality was 24 (%75). Age (p=0.03), need for dialysis (p=0.01), emergency cardiac operation (p=0.05),
peripheral arterial disease (p=0.001), and high risk Euroscore (p=0.0001) were significantly different compared to the control group. Mesenteric
ischemia was significantly higher in off- pump coronary artery bypass patients (p=0.0001). The time of cardiopulmonary bypass in mesenteric
ischemia group was significantly higher than the control group (p=0.0001).

Conclusion: Acute mesenteric ischemia is still highly mortal, after cardiac surgery. Splenic infarct symptoms may mimic mesenteric ischemia.
Mesenteric ischemia is more common in high-risk cardiac operations. Prompt diagnosis and treatment can be life-saving.

Anahtar Kelimeler

Mesenteric Ischemia Splenic Infarction Cardiac Surgery

Proje Numarası

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Kaynakça

  • 1. Christenson JT, Schmuziger M, Maurice J, et al. Postoperative visceral hypotension the common cause for gastrointestinal complications after cardiac surgery. Thorac Cardiovasc Surg. 1994;42:152-157.
  • 2. Zacharias A, Schwann TA, Parenteau GL, et al. Predictors of gastrointestinal complications in cardiac surgery. Tex Heart Inst J. 2000;27:93-99.
  • 3. Mangi AA, Christison-Lagay ER, Torchiana DF, et al. Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients. Ann Surg. 2005;241:895-901.
  • 4. Bolcal C, Iyem H, Sargin M, et al. Gastrointestinal complications after cardiopulmonary bypass: sixteen years of experience. Can J Gastroenterol. 2005;19:613-617.
  • 5. Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery. Ann Surg. 2007;246:323- 329.
  • 6. Acosta-Merida MA, Marchena-Gomez J, Hemmersbach-Miller M, et al. Identification of risk factors for perioperative mortality in acute mesenteric ischemia. World J Surg. 2006;30:1579-1585.
  • 7. Schoots IG, Koffeman GI, Legemate DA, et al. Systematic review of survival after acutemesenteric ischaemia according to disease aetiology. Br J Surg. 2004;91:17-27.
  • 8. Merle C, Lepouse C, de Garine A, et al. Surgery for mesenteric infarction: prognostic factors associated with early death within 72 hours. J Cardiothorac Vasc Anesth. 2004;18:734-741.
  • 9. Park WM, Gloviczki P, Cherry Jr K.J, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg. 2002;35:445-452.
  • 10. Chaudhuri N, James J, Sheikh A, et al. Intestinal ischaemia following cardiac surgery: a multivariate risk model. Eur J Cardiothorac Surg. 2006;29:971- 977.
  • 11. Garofalo M, Borioni R, Nardi P, et al. Early diagnosis of acute mesenteric ischemia after cardiopulmonary bypass. J Cardiovasc Surg (Torino). 2002;43:455-459.
  • 12. Yasuhara H. Acute mesenteric ischemia: the challenge of gastroenterology. Surg Today. 2005;35:185-195.
  • 13. Blauth CI, Cosgrove DM, Webb BW, et al. Atheroembolism from the ascending aorta. An emerging problem in cardiac surgery. J Thorac Cardiovasc Surg. 1992;103:1104-1111.
  • 14. Cernilia J, Godbe DH, Ott R, et al. Splenic infarction from cholesterol embolization following cardiopulmonary bypass. Cardiovasc Surg. 1995;3:607-610.
  • 15. Woo K, Major K, Kohanzadeh S, et al. Laparotomy for visceral ischemia and gangrene. Am Surg. 2007;73:1006-1008.
  • 16. Hamada T, Yamauchi M, Tanaka M, et al. Prospective evaluation of contrastenhanced ultrasonography with advanced dynamic flow for the diagnosis of intestinal ischaemia. Br J Radiol. 2007;80:603-608.
  • 17. Ofer A, Abadi S, Nitecki S, et al. Multidetector CT angiography in the evaluation of acute mesenteric ischemia. Eur Radiol. 2009;19:24-30.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kardiyovasküler Tıp ve Hematoloji (Diğer)
Bölüm Makaleler
Yazarlar

Çağdaş Baran 0000-0003-4079-4442

Proje Numarası -
Yayımlanma Tarihi 2 Ekim 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 72 Sayı: 2

Kaynak Göster

APA Baran, Ç. (2019). Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 72(2), 247-250. https://doi.org/10.4274/atfm.galenos.2019.29484
AMA Baran Ç. Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Ekim 2019;72(2):247-250. doi:10.4274/atfm.galenos.2019.29484
Chicago Baran, Çağdaş. “Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72, sy. 2 (Ekim 2019): 247-50. https://doi.org/10.4274/atfm.galenos.2019.29484.
EndNote Baran Ç (01 Ekim 2019) Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72 2 247–250.
IEEE Ç. Baran, “Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 2, ss. 247–250, 2019, doi: 10.4274/atfm.galenos.2019.29484.
ISNAD Baran, Çağdaş. “Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72/2 (Ekim 2019), 247-250. https://doi.org/10.4274/atfm.galenos.2019.29484.
JAMA Baran Ç. Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2019;72:247–250.
MLA Baran, Çağdaş. “Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 72, sy. 2, 2019, ss. 247-50, doi:10.4274/atfm.galenos.2019.29484.
Vancouver Baran Ç. Acute Mesenteric Ischemia and Splenic Infarct After Coronary Bypass Surgery: An Analysis of 32 Patients. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2019;72(2):247-50.
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