Browsing by Author "Ercan, Arzu"
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Item Preoperatif statin tedavisinin koroner bypass cerrahisi sonrası kardiyak mortalite ve morbidite üzerine etkilerinin araştırılması(Uludağ Üniversitesi, 2007) Ercan, Arzu; Cengiz, Mete; Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi Anabilim Dalı.Preoperatif atorvastatin kullanımının çalışan kalpte koroner cerrahisi sonrası kardiyak morbidite ve mortalite üzerine etkilerini araştırmak üzere ileri dönük, kontrollü klinik çalışma planlandı. Çalışan kalpte koroner cerrahisi yapılacak toplam 30 koroner arter hastası 2 gruba ayrıldı. Grup 1 (n=15) hastalar cerrahi öncesi atorvastatin kullanan, Grup 2 (n=15)’ dekiler ise statin tedavisi almayan hastalardı ve kontrol grubu olarak çalışmaya alındılar. Tüm hastalarda kreatin kinaz MB (CK-MB), Troponin I (Tn I) ölçümleri cerrahi öncesi, postoperatif 4. saatte, 12. saatte, 24. saatte ve 48. saatte yapıldı. Preoperatif risk profilleri, operatif değişkenler, ameliyata ait veriler, atriyal fibrilasyon atakları, morbidite ve mortalite kaydedildi. Preoperatif risk profilleri ve operatif değişkenler karşılaştırıldığında her iki grup arasında fark yoktu. Tn I ve CK-MB değerleri koroner bypass sonrası anlamlı olarak yükseldi ancak gruplar arasında anlamlı fark yoktu. Ortalama oklüzyon süreleri Grup 1’ deki hastalarda 7.1±0.7 dakika, Grup 2’ deki hastalarda 6.9±0.9 dakika idi ve gruplar arası istatiksel anlamlı fark yoktu. Postoperatif değişkenlere bakıldığında atorvastatin alan grupta 1 hastada AF gelişirken kontrol grubunda 2 hastada gelişti ve istatiksel anlamlı fark yoktu. Hastane mortalitesi, nörolojik komplikasyon, miyokard enfarktüsü ve yetmezlik gelişmedi. Bu çalışma ameliyat öncesi atorvastatin kullanımının çalışan kalpte koroner bypass cerrahisinde iskemi süresinin kısa olduğu durumlarda iskemireperfüzyon hasarının azaltılmasında önemli etkisi olmadığını ve atriyal fibrilasyon insidansını azaltmadığını göstermiştir.Item Vascular complications of intra-aortic balloon pump usage in coronary bypass surgery: 18 years of experience(Pakistan Medical Assoc, 2014-01) Ercan, Abdülkadir; Gürbüz, Orçun; Ercan, Arzu; Özkan, Hayati; Tüydeş, Oktay; Biçer, Murat; Saba, Davit; Uludağ Üniversitesi/Tıp Fakültesi/Kalp Damar Cerrahisi Anabilim Dalı.; ABC-2231-2020; 36115722000; 6507770944; 55987378200Objective: To evaluate the vascular complication incidence related to intra-aortic balloon pump usage during coronary bypass surgery and possible risk factors. Methods: The retrospective study was conducted at Uludog University Hospital, Turkey, and comprised 147 cases in which intra-aortic balloon pump was used during coronary artery bypass surgery between January 1994 and December 2011. Data was examined in terms of age, gender, diabetes mellitus, hypertension, smoking, peripheral vascular disease, pre-operative serum creatinine, history of congestive heart failure, left ventricular ejection fraction, previous infarction and cardiac functional capacity. Time, indication, treatment duration, technique of insertion and complications were recorded about the balloon insertion. Patients in whom peripheral vascular complication developed were evaluated with pulse examination, Doppler ultrasound and angiography. Logistic regression analyses were carried out with the purpose of determining the relation between pre-operative clinical variables and vascular complications and mortality. Results: Of the total, 105 (71%) were males and 42 (28%) were females. The overall mean age was 62.4 +/- 10.1 years. Besides, 16(41%) cases had diabetes mellitus and 30(20%) had peripheral artery disease. The mean Euroscore was 7.6 +/- 4.8. Intra-aortic balloon pump was inserted in 16 (10.8%) due to pre-operative high risk and in 75 (51%) cases due to hypotension being non-responsive to inotropes. Balloon catheter was placed with percutaneous technique in 141 (96%) cases and sheath wasn't used in 44 (29%). The balloon stayed for 2.9 +/- 2.1 days on average. Balloon rupture developed in 1 (0.6%) case. Mortality resulted in 58 (39%) cases. Euroscore (p=0.012), staying in hospital (p=0.005), low ejection fraction (p=0.018), hypertension existence (p=0.003) in multivariate logistic regression analyses were found significant in terms of affecting mortality. Duration of therapy (p<0.001), existence of sheath (p=0.002), and existence of peripheral vascular disease (p<0.001) were found significant as factors affecting the development of vascular complication. Conclusion: Intra-aortic balloon pump provides mechanical circulation assistance during coronary artery surgery, but peripheral vascular system should be well evaluated in order to avoid vascular complications and the balloon catheter should be placed without the sheath if necessary. The duration of the therapy is a risk factor for the development of vascular complication.