Sol ventrikül mekanik dolaşım destek cihazı sonrası kalp nakli yapılan hastalarda erken dönem sağkalım belirleyicilerinin retrospektif araştırılması
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu araştırmada kalp transplantasyonuna kadar mekanik dolaşım destek cihazı ile desteklenen hastalarda transplantasyon sonrası erken dönemde sağkalıma etki eden faktörleri belirlemek amaçlanmıştır.
Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Anabilim Dalı’nda Haziran 2011 ile Mart 2019 arasında HeartWare HVAD, HeartMate II, HeartMate III ventrikül destek cihazlarından herhangi biri ile takipteyken kalp transplantasyonu yapılan hasta verilerine ulaşılan 60 hasta çalışmaya dahil edilmiştir. Yaş, cinsiyet, etiyoloji, ek hastalıklar, donör özellikleri, preoperatif hemodinamik veriler, biyokimyasal değerler, rejeksiyon, cerrahi ve medikal komplikasyonlara ilişkin veriler retrospektif olarak incelenmiştir. Bu etmenlerin 30 günlük mortaliteye etkisi; önce tek değişkenli (univaryant), sonra çok değişkenli (multivaryant) yöntemlerle analiz edilmiştir. Pediatrik hastalar (<18 yaş), HeartMate II, HeartMate III veya HeartWare HVAD dışında bir sol ventrikül destek cihazı (LVAD) implante edilmiş olan hastalar, hasta kayıtlarında çalışma verileri bulunamayan hastalar çalışmaya dahil edilmemiştir. Çalışmada toplanan verilerin analizi, istatistiksel yazılım paketi SPSS 24 (Statistical Package for the Social Sciences – IBM®) kullanılarak analizi yapılmış ve elde edilen sonuçlar %95’lik güven aralığında, p<0,05 değeri anlamlı kabul edilerek değerlendirilmiştir.
Bulgular: Çalışmamızda incelediğimiz hastalar Grup 1 ve Grup 2 olarak ikiye ayrılmış olup; Grup 1 transplantasyon sonrası ilk 30 günde kaybedilen hastaları, Grup 2 ise transplantasyon sonrası ilk 30 günde yaşayan hastaları içermektedir. Grup 1’de yer alan hastaların %80’i, Grup 2’de yeralan hastaların ise %78’i erkekti. Grup 1’de yer alan hastaların yaş ortalaması Grup 2’de yer alan hastalardan daha yüksekti. Çalışmada Grup 1’de yer alan hastaların kardiyak iskemi süresi ve kardiyopulmoner bypass süresi ortalaması Grup 2’de yer alan hastaların ortalamasından daha uzundu. Grup 1’deki hastaların hastanede kalma süresi Grup 2’den daha kısaydı. Her iki grup arasında yaş, kardiyak iskemi süresi ve kardiyopulmoner bypass süresi bakımından anlamlı fark tespit edildi (p<0,05). Çalışmada donörlerin %35’i kadın, %65’i erkekti. Her iki grup arasında kan ve kan ürünü transfüzyonu verilme durumu bakımından anlamlı farklar tespit edildi (p<0,05). Her iki grup arasında inme, sepsis, böbrek yetersizliği gelişmesi, IABP ve VAD desteği bakımından anlamlı bir fark olduğu saptandı (p<0,05). LVEF ve RVEF ortalama değerlerinin Grup 2’de yer alan hastalarda daha yüksek olduğu gözlendi. Grup 1’de yer alan hastaların bilirubin, kreatinin, 3 günlük ortalama laktat ve LDH ortalama değerlerinin Grup 2’ye göre anlamlı olarak yüksek olduğu tespit edildi (p<0,05). Grup 1’de yeralan hastaların %60’ına HeartWare HVAD, %40’ına HeartMate II takıldığı saptandı. Grup 2’de yeralan hastaların ise %74’üne HeartWare HVAD, %16’sına HeartMate II takıldığı tespit edildi.
Sonuç: Çalışma sonucunda kalp transplantasyonuna kadar mekanik dolaşım destek cihazı ile desteklenen hastalarda transplantasyon sonrası erken dönemde sağkalıma etki eden faktörlerin alıcının ve donörün yaşı, alıcının ve donörün kan grupları, kardiyak iskemi süresi, postop kreatinin düzeyinin yüksek olması, CPB süresinin 130 dk’ yı geçmesi, laktat düzeyi, kan ve kan ürünleri verilmesi ile preoperatif cihaz enfeksiyonu olduğu belirlenmiştir. Mekanik dolaşım destek cihazı ile desteklenen hastaların transplantasyon sonrası mortalite oranlarının en aza indirmek ve sağlıklı yaşam sürelerini uzatmak için oluşabilecek komplikasyonların önlenmesi ve tedavi seçeneklerinin öngörülebilirliği konusunda yapılacak çok merkezli geniş seriler içeren çalışmalara ihtiyaç vardır.
Aim: In this study, it was aimed to determine the factors affecting survival in the early period after transplantation in patients who were supported with a mechanical circulation support device until heart transplantation. Materials and Methods: Sixty patients who had heart transplantation with any of HeartWare HVAD, HeartMate II, HeartMate III ventricular assist devices between June 2011 and March 2019 at Ege University Faculty of Medicine Department of Cardiovascular Surgery were included in the study. Data on age, gender, etiology, comorbidities, donor characteristics, preoperative hemodynamic data, biochemical values, rejection, surgical and medical complications were analyzed retrospectively. The effect of these factors on 30-day mortality; first, univariate, then multivariate (multivariate) methods were analyzed. Pediatric patients (<18 years), patients who were implanted with a left ventricular assist device (LVAD) other than HeartMate II, HeartMate III, or HeartWare HVAD, patients whose patient records did not have study data were excluded from the study. The analysis of the data collected in the study was analyzed using the statistical software package SPSS 24 (Statistical Package for the Social Sciences - IBM®) and the results obtained were evaluated at a 95% confidence interval, with p <0.05 considered significant. Results: The patients we examined in our study were divided into two as Group 1 and Group 2; Group 1 includes patients who died in the first 30 days after transplantation, Group 2 includes patients who survived in the first 30 days after transplantation. 80% of the patients in Group 1 and 78% of the patients in Group 2 were male. The average age of the patients in Group 1 was higher than the patients in Group 2. In the study, the average cardiac ischemia time and cardiopulmonary bypass time of the patients in Group 1 were longer than the average of the patients in Group 2. The hospitalization period of the patients in Group 1 was shorter than Group 2. There was a significant difference between the two groups in terms of age, cardiac ischemia time and cardiopulmonary bypass time (p <0.05). 35% of the donors in the study were women and 65% were men. Significant differences were found between the two groups in terms of giving blood and blood product transfusion (p <0.05). A significant difference was found between the two groups in terms of stroke, sepsis, renal failure, IABP and VAD support (p <0.05). LVEF and RVEF mean values were observed to be higher in patients in Group 2. It was determined that the average bilirubin, creatinine, 3-day average lactate and LDH values of the patients in Group 1 were significantly higher than Group 2 (p <0.05). It was found that 60% of the patients in Group 1 had HeartWare HVAD and 40% of them had HeartMate II. It was found that 74% of the patients in Group 2 had HeartWare HVAD and 16% of them had HeartMate II. Conclusion: As a result of the study, factors affecting the survival of the recipient and donor in the early period after transplantation, the recipient's and donor's blood types, cardiac ischemia time, high postoperative creatinine level, CPB duration exceeding 130 minutes, lactate in patients supported with mechanical circulation support device until heart transplantation preoperative device infection was detected with blood levels, blood and blood products. There is a need for multi-center, large series studies to be conducted on the predictability of treatment options and prevention of complications that may occur in order to minimize post-transplantation mortality rates and extend healthy life expectancy of patients supported with a mechanical circulatory support device.
Aim: In this study, it was aimed to determine the factors affecting survival in the early period after transplantation in patients who were supported with a mechanical circulation support device until heart transplantation. Materials and Methods: Sixty patients who had heart transplantation with any of HeartWare HVAD, HeartMate II, HeartMate III ventricular assist devices between June 2011 and March 2019 at Ege University Faculty of Medicine Department of Cardiovascular Surgery were included in the study. Data on age, gender, etiology, comorbidities, donor characteristics, preoperative hemodynamic data, biochemical values, rejection, surgical and medical complications were analyzed retrospectively. The effect of these factors on 30-day mortality; first, univariate, then multivariate (multivariate) methods were analyzed. Pediatric patients (<18 years), patients who were implanted with a left ventricular assist device (LVAD) other than HeartMate II, HeartMate III, or HeartWare HVAD, patients whose patient records did not have study data were excluded from the study. The analysis of the data collected in the study was analyzed using the statistical software package SPSS 24 (Statistical Package for the Social Sciences - IBM®) and the results obtained were evaluated at a 95% confidence interval, with p <0.05 considered significant. Results: The patients we examined in our study were divided into two as Group 1 and Group 2; Group 1 includes patients who died in the first 30 days after transplantation, Group 2 includes patients who survived in the first 30 days after transplantation. 80% of the patients in Group 1 and 78% of the patients in Group 2 were male. The average age of the patients in Group 1 was higher than the patients in Group 2. In the study, the average cardiac ischemia time and cardiopulmonary bypass time of the patients in Group 1 were longer than the average of the patients in Group 2. The hospitalization period of the patients in Group 1 was shorter than Group 2. There was a significant difference between the two groups in terms of age, cardiac ischemia time and cardiopulmonary bypass time (p <0.05). 35% of the donors in the study were women and 65% were men. Significant differences were found between the two groups in terms of giving blood and blood product transfusion (p <0.05). A significant difference was found between the two groups in terms of stroke, sepsis, renal failure, IABP and VAD support (p <0.05). LVEF and RVEF mean values were observed to be higher in patients in Group 2. It was determined that the average bilirubin, creatinine, 3-day average lactate and LDH values of the patients in Group 1 were significantly higher than Group 2 (p <0.05). It was found that 60% of the patients in Group 1 had HeartWare HVAD and 40% of them had HeartMate II. It was found that 74% of the patients in Group 2 had HeartWare HVAD and 16% of them had HeartMate II. Conclusion: As a result of the study, factors affecting the survival of the recipient and donor in the early period after transplantation, the recipient's and donor's blood types, cardiac ischemia time, high postoperative creatinine level, CPB duration exceeding 130 minutes, lactate in patients supported with mechanical circulation support device until heart transplantation preoperative device infection was detected with blood levels, blood and blood products. There is a need for multi-center, large series studies to be conducted on the predictability of treatment options and prevention of complications that may occur in order to minimize post-transplantation mortality rates and extend healthy life expectancy of patients supported with a mechanical circulatory support device.
Açıklama
Anahtar Kelimeler
Ventrikül Destek Cihazı, Kalp Transplantasyonu, Sağkalım, HeartMate II, HeartMate III, HeartWare HVAD, Ventricle Assist Device, Heart Transplantation, Survival, HeartMate II, HeartMate III, HeartWare HVAD
