Kalp nakli sonrası mortaliteyi etkileyen preoperatif ve intraoperatif risk faktörleri: Tek merkez deneyimi
Küçük Resim Yok
Tarih
2011
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kalp nakli yapılan olgularda mortaliteye etki eden risk faktörlerini belirlemek için merkezimizdeki olguları retrospektif olarak inceledik. Yöntemler: Şubat 1998-Nisan 2009 arasında kalp nakli yapılan 123 hastanın (ortalama yaş 40.6±14 yıl, 97'si erkek) verileri incelendi. Nakil sonrası sağ kalan 73 olgu (Grup 1, ortalama yaş 39.1±14.6, 58'i erkek) ve izlemde kaybedilen 50 olgunun preoperatif ve intraoperatif verileri (Grup 2, ortalama yaş 42.6±12.9, 39'u erkek) karşılaştırıldı. İstatistiksel analiz için Student t, Mann-Whitney U ve Ki-kare testi kullanıldı. Mortaliteyi etkileyen bağımsız risk faktörlerinin saptanması için lojistik regresyon analizi yapıldı, sağkalım analizi de Kaplan-Meier analizi ile gerçekleştirildi. Bulgular: Genel mortalite oranı %40.6 (50/123) ve sırasıyla 1, 2, 5 ve 10 yıllık sağkalım oranı %74, %65, %51 ve %31 olarak saptandı. Kalp nakli sonrası en önemli ölüm sebepleri enfeksiyonlar (%30), sağ ventrikül yetmezliği (%18), rejeksiyon (%12) ve ani ölüm (%12) olarak saptandı. Toplam iskemi zamanı 176.7±63.3 dakika (90 ile 410 dakika arası) olarak bulundu. Toplam kardiyopulmoner baypas (KPB) zamanı (114.3±27.7'ye karşı 126.9±42.1 dak, p=0.05), preoperatif kreatinin klirensi (81.0±31.5'e karşı 67.2±33.0 ml/dak, p=0.02), üre düzeyi (45.2±18.6'ya karşı 57.8±35.2 mg/dl, p=0.02), kreatinin düzeyi (1.01±0.25'e karşı 1.17±0.36 mg/dl, p=0.05) sağ kalan grup ile izlemde kaybedilen grup arasında istatistiksel olarak anlamlı düzeyde farklı bulundu. İkinci grupta transpulmoner gradiyent (TPG) diğer gruba göre anlamlı olarak daha yüksek bulundu (9.21±5.16'ya karşı 12.50±8.26 mmHg, p=0.02). Lojistik regresyon analizinde kreatinin klirensi (OR 0.989, %95 GA 0.973-1.005, p=0.044), preoperatif kreatinin düzeyi (OR 2.028, %95 GA 0.288-14.301, p=0.027), toplam KPB zamanı (OR 1.013, %95 GA 1.000-1.027, p=0.036), TPG’in (OR 1.113, %95 GA 0.992-1.249, p=0.045) mortalitenin bağımsız öngördürücüleri oldukları saptandı. Sonuç: Toplam KPB zamanı, TPG ve nakil öncesi böbrek fonksiyon bozukluğu kalp nakli sonrası mortaliteye yol açan preoperatif ve intraoperatif risk faktörleridir.
Objective: We retrospectively analyzed case records to identify risk factors for mortality in heart transplant recipients in our center. Methods: Data of 123 patients (mean age 40.6±14 years and 97 male) transplanted from February 1998 to April 2009 were studied and analyzed. Pre- and intra-operative variables of the 73 patients who survived (Group 1, mean age 39.1±14.6, 58 male) and 50 patients who died (Group 2, mean age 42.6±12.9, 39 male) were compared. For statistical analysis Student t, Mann-Whitney U and Chi-square tests were used. Logistic regression analysis was used to determine independent risk factors for mortality and survival analysis was accomplished using Kaplan-Meier analysis. Results: Overall mortality in the entire population was 40.6% (50/123). Actuarial survival was 74%, 65%, 51% and 31% at 1, 2, 5 and 10 years respectively. Major causes of death after heart transplantation were infections (30%), right ventricular failure (18%), rejection (12%) and sudden cardiac death (12%). Total ischemic time was 176.7±63.3 minutes (range 90-410 minutes). The total cardiopulmonary by-pass (CPB) time (114.3±27.7 vs 126.9±42.1 min, p=0.05), pre-operative creatinine clearance (81.0±31.5 vs 67.2±33.0 ml/min, p=0.02), urea (45.2±18.6 vs 57.8±35.2 mg/dl, p=0.02), and creatinine (1.01±0.25 vs 1.17±0.36 mg/dl, p=0.05) were significantly different between survivors and non-survivors. Group 2 patients had higher transpulmonary gradient (TPG) (9.21±5.16 vs 12.50±8.26 mmHg, p=0.02) as compared with group 1 patients. Logistic regression analysis revealed that preoperative creatinine clearance (OR 0.989, 95% CI 0.973-1.005, p=0.044), creatinine level (OR 2.028, 95% CI 0.288-14.301, p=0.027), total CPB time (OR 1.013, 95% CI 1.000-1.027, p=0.036), and TPG (OR 1.113, 95% CI 0.992 1.249, p=0.045) were the independent predictors of mortality. Conclusion: Our data showed that TPG, total CPB time, pre-transplant renal dysfunction are pre-operative and intra-operative risk factors for mortality after heart transplantation.
Objective: We retrospectively analyzed case records to identify risk factors for mortality in heart transplant recipients in our center. Methods: Data of 123 patients (mean age 40.6±14 years and 97 male) transplanted from February 1998 to April 2009 were studied and analyzed. Pre- and intra-operative variables of the 73 patients who survived (Group 1, mean age 39.1±14.6, 58 male) and 50 patients who died (Group 2, mean age 42.6±12.9, 39 male) were compared. For statistical analysis Student t, Mann-Whitney U and Chi-square tests were used. Logistic regression analysis was used to determine independent risk factors for mortality and survival analysis was accomplished using Kaplan-Meier analysis. Results: Overall mortality in the entire population was 40.6% (50/123). Actuarial survival was 74%, 65%, 51% and 31% at 1, 2, 5 and 10 years respectively. Major causes of death after heart transplantation were infections (30%), right ventricular failure (18%), rejection (12%) and sudden cardiac death (12%). Total ischemic time was 176.7±63.3 minutes (range 90-410 minutes). The total cardiopulmonary by-pass (CPB) time (114.3±27.7 vs 126.9±42.1 min, p=0.05), pre-operative creatinine clearance (81.0±31.5 vs 67.2±33.0 ml/min, p=0.02), urea (45.2±18.6 vs 57.8±35.2 mg/dl, p=0.02), and creatinine (1.01±0.25 vs 1.17±0.36 mg/dl, p=0.05) were significantly different between survivors and non-survivors. Group 2 patients had higher transpulmonary gradient (TPG) (9.21±5.16 vs 12.50±8.26 mmHg, p=0.02) as compared with group 1 patients. Logistic regression analysis revealed that preoperative creatinine clearance (OR 0.989, 95% CI 0.973-1.005, p=0.044), creatinine level (OR 2.028, 95% CI 0.288-14.301, p=0.027), total CPB time (OR 1.013, 95% CI 1.000-1.027, p=0.036), and TPG (OR 1.113, 95% CI 0.992 1.249, p=0.045) were the independent predictors of mortality. Conclusion: Our data showed that TPG, total CPB time, pre-transplant renal dysfunction are pre-operative and intra-operative risk factors for mortality after heart transplantation.
Açıklama
Anahtar Kelimeler
Kalp ve Kalp Damar Sistemi
Kaynak
Anadolu Kardiyoloji Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
11
Sayı
2
