Klinik Araştırma
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Kalp Cerrahisinde Pulsatil ve Nonpulsatil Akımların Preoperatif ve Postoperatif Etkilerinin Karşılaştırılması

Yıl 2023, Cilt: 3 Sayı: 3, 24 - 28, 22.12.2023
https://doi.org/10.58961/hmj.1400797

Öz

Amaç
Açık kalp cerrahisinde kardiyopulmoner bypass (KPB) sırasında pulsatil veya nonpulsatil olmak üzere iki farklı akış modeli kullanılmaktadır. Ancak bu iki modelin farklılıkları ve üstünlükleri konusunda belirsizlikler vardır. Bu çalışmada izole koroner arter bypass cerrahisinde (CABG) pulsatil ve nonpulsatil akış tiplerinin biyokimyasal ve klinik sonuçlarının karşılaştırılması amaçlanmıştır.
Yöntem
Haziran 2019 ile Haziran 2020 arasında tarihleri arasında yapılan bu prospektif çalışmaya izole CABG ameliyatı yapılan 30 hasta dahil edildi. Hastalar pulsatil (Grup I; n=15) ve nonpulsatil (Grup II; n=15) akış olarak iki gruba ayrıldı. Gruplardan preoperatif, postoperatif 24.saat ve postoperatif 72.saat hemogram örneği ve kreatinin düzeyleri; KPB öncesi, kros klemp 5.dakika, KPB sonu ve postoperatif 2.saat laktat düzeyleri kaydedildi. Her iki grup için postoperatif 24.saat drenaj ve diürez miktarları, yoğun bakım ünitesi ekstübasyon, yoğun bakım ünitesi çıkış ve hastaneden taburculuk süreleri karşılaştırıldı.
Bulgular
İki grup arasında hemogram ve diğer kan örnekleri açısından anlamlı bir farklılık bulunmadı (p>0,05). Gruplar arasında ekstübasyon süresi, yoğun bakım çıkış ve taburculuk süreleri benzerdi (p>0,05). Bununla beraber gruplar arasında drenaj açısından anlamlı farklılık tespit edildi (p<0,05).
Sonuç
İzole koroner arter bypass cerrahisinde pulsatil ve nonpulsatil akış modelinin, biyokimyasal ve klinik sonuçlar açısından majör bir farklılık göstermediği tespit edildi.

Etik Beyan

Herhangi bir çıkar çatışması yoktur.

Kaynakça

  • Onorati F, Presta P, Fuiano G, Mastroroberto P, Comi N, Pezzo F, Tozzo C, Renzulli A. A randomized trial of pulsatile perfusion using an intra-aortic balloon pump versus nonpulsatile perfusion on short-term changes in kidney function during cardiopulmonary bypass during myocardial reperfusion. Am J KidneyDis. 2007 Aug;50(2):229-38. doi: 10.1053/j.ajkd.2007.05.017. PMID: 17660024.
  • Koning NJ, Vonk AB, van Barneveld LJ, Beishuizen A, Atasever B, van den Brom CE, Boer C. Pulsatile flow during cardiopulmonary bypass preserves postoperative microcirculatory perfusion irrespective of systemic hemodynamics. J Appl Physiol (1985). 2012 May;112(10):1727-34. doi: 10.1152/japplphysiol.01191.2011. Epub 2012 Mar 8. PMID: 22403352.
  • Zamparelli R, De Paulis S, Martinelli L, Rossi M, Scapigliati A, Sciarra M, Meo F, Schiavello R. Pulsatile normothermic cardiopulmonary bypass and plasma catecholamine levels. Perfusion. 2000 Jun;15(3):217-23. doi: 10.1177/026765910001500306. PMID: 10866423.
  • Ji B, Undar A. An evaluation of the benefits of pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass procedures in pediatric and Adult cardiac patients. ASAIO J. 2006 Jul-Aug;52(4):357-61. doi: 10.1097/01.mat.0000225266.80021.9b. PMID: 16883112.
  • Poswal P, Mehta Y, Juneja R, Khanna S, Meharwal ZS, Trehan N. Comparativestudy of pulsatile and nonpulsatile flow during cardio-pulmonary bypass. Ann CardAnaesth. 2004 Jan;7(1):44-50. PMID: 17827561.
  • Tan Z, Besser M, Anderson S, Newey C, Iles R, Dunning J, Falter F. Pulsatile Versus Nonpulsatile Flow During Cardiopulmonary Bypass: Extent of Hemolysis and Clinical Significance. ASAIO J. 2020 Sep/Oct;66(9):1025-1030. doi: 10.1097/MAT.0000000000001154. PMID: 32224786.
  • Song Z, Wang C, Stammers AH. Clinical comparison of pulsatile and nonpulsatile perfusion during cardiopulmonary bypass. J ExtraCorpor Technol. 1997 Dec;29(4):170-5. PMID: 10176125.
  • Geha AS, Salaymeh MT, Abe T, Baue AE. Effect of pulsatile cardiopulmonary bypass on cerebral metabolism. J SurgRes. 1972 Jun;12(6):381-7. doi: 10.1016/0022-4804(72)90088-1. PMID: 5037460.
  • Louagie YA, Gonzalez M, Collard E, Mayné A, Gruslin A, Jamart J, Buche M, Schoevaerdts JC. Does flow character of cardiopulmonary bypass make a difference? J Thorac Cardiovasc Surg. 1992 Dec;104(6):1628-38. PMID: 1453728.
  • Adademir T, Ak K, Aljodi M, Elçi ME, Arsan S, Isbir S. The effects of pulsatile cardiopulmonary bypass on acute kidney injury. Int J ArtifOrgans. 2012 Jul;35(7):511-9. doi: 10.5301/ijao.5000097. PMID: 22466997.
  • Sezai A, Shiono M, Nakata K, Hata M, Iida M, Saito A, Hattori T, Wakui S, Soeda M, Taoka M, Umeda T, Negishi N, Sezai Y. Effects of pulsatile CPB on interleukin-8 andendothelin-1 levels. ArtifOrgans. 2005 Sep;29(9):708-13. doi: 10.1111/j.1525-1594.2005.29112.x. PMID: 16143012.
  • Gu YJ, vanOeveren W, Mungroop HE, Epema AH, den Hamer IJ, Keizer JJ, Leuvenink RP, Mariani MA, Rakhorst G. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients under going cardiacsurgery. ArtifOrgans. 2011 Feb;35(2):E18-26. doi: 10.1111/j.1525-1594.2010.01152.x. Epub 2011 Feb 14. PMID: 21314839.
  • Baraki H, Gohrbandt B, Del Bagno B, Haverich A, Boethig D, Kutschka I. Does pulsatile perfusion improve outcome after cardiac surgery? A propensity-matched analysis of 1959 patients. Perfusion. 2012 May;27(3):166-74. doi: 10.1177/0267659112437419. Epub 2012 Feb 6. PMID: 22312012.
  • Serraino GF, Marsico R, Musolino G, Ventura V, Gulletta E, Santè P, Renzulli A. Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves organ function and reduces endothelial activation. Circ J. 2012;76(5):1121-9. doi: 10.1253/circj.cj-11-1027. Epub 2012 Mar 7. PMID: 22447003.
  • Onorati F, Esposito A, Comi MC, Impiombato B, Cristodoro L, Mastroroberto P, Renzulli A. Intra-aortic balloon pump-induced pulsatile flow reduces coagulative and fibrinolytic response to cardiopulmonary bypass. ArtifOrgans. 2008 Jun;32(6):433-41. doi: 10.1111/j.1525-1594.2008.00563.x. Epub 2008 Apr 16. PMID: 18422802.

Comparison of Preoperative and Postoperative Effects of Pulsatile and Non-Pulsatile Currents in Cardiac Surgery

Yıl 2023, Cilt: 3 Sayı: 3, 24 - 28, 22.12.2023
https://doi.org/10.58961/hmj.1400797

Öz

Objective
Two different flow patterns, pulsatile or nonpulsatile, are used during cardiopulmonary bypass (CPB) in open heart surgery. However, there are uncertainties about the differences and superiorities of these two models. The aim of this study was to compare the biochemical and clinical outcomes of pulsatile and nonpulsatile flow types in isolated coronary artery bypass surgery (CABG).
Methods
This prospective study was conducted between June 2019 and June 2020. 30 patients who underwent isolated CABG surgery were included. Patients received pulsatile (Group I; n=15) and nonpulsatile flow (Group II; n=15) were divided into two groups. The groups were divided into preoperative, postoperative 24.hour and 72.hour postoperative hemogram samples and creatinine levels; pre-CPB, cross Lactate levels were recorded at 5 minutes after clamping, at the end of CPB and 2 hours postoperatively. For both groups postoperative 24th hour drainage and diuresis, intensive care unit extubation, intensive care unit discharge and hospital discharge times were compared.
Results
There was no significant difference between the two groups in terms of hemogram and other blood samples (p>0.05). Extubation time, ICU discharge and discharge times were similar between the groups (p>0.05). However, there was a significant difference between the groups in terms of drainage (p<0.05).
Conclusion
It was found that pulsatile and nonpulsatile flow model did not show a major difference in terms of biochemical and clinical outcomes in isolated coronary artery bypass surgery.

Kaynakça

  • Onorati F, Presta P, Fuiano G, Mastroroberto P, Comi N, Pezzo F, Tozzo C, Renzulli A. A randomized trial of pulsatile perfusion using an intra-aortic balloon pump versus nonpulsatile perfusion on short-term changes in kidney function during cardiopulmonary bypass during myocardial reperfusion. Am J KidneyDis. 2007 Aug;50(2):229-38. doi: 10.1053/j.ajkd.2007.05.017. PMID: 17660024.
  • Koning NJ, Vonk AB, van Barneveld LJ, Beishuizen A, Atasever B, van den Brom CE, Boer C. Pulsatile flow during cardiopulmonary bypass preserves postoperative microcirculatory perfusion irrespective of systemic hemodynamics. J Appl Physiol (1985). 2012 May;112(10):1727-34. doi: 10.1152/japplphysiol.01191.2011. Epub 2012 Mar 8. PMID: 22403352.
  • Zamparelli R, De Paulis S, Martinelli L, Rossi M, Scapigliati A, Sciarra M, Meo F, Schiavello R. Pulsatile normothermic cardiopulmonary bypass and plasma catecholamine levels. Perfusion. 2000 Jun;15(3):217-23. doi: 10.1177/026765910001500306. PMID: 10866423.
  • Ji B, Undar A. An evaluation of the benefits of pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass procedures in pediatric and Adult cardiac patients. ASAIO J. 2006 Jul-Aug;52(4):357-61. doi: 10.1097/01.mat.0000225266.80021.9b. PMID: 16883112.
  • Poswal P, Mehta Y, Juneja R, Khanna S, Meharwal ZS, Trehan N. Comparativestudy of pulsatile and nonpulsatile flow during cardio-pulmonary bypass. Ann CardAnaesth. 2004 Jan;7(1):44-50. PMID: 17827561.
  • Tan Z, Besser M, Anderson S, Newey C, Iles R, Dunning J, Falter F. Pulsatile Versus Nonpulsatile Flow During Cardiopulmonary Bypass: Extent of Hemolysis and Clinical Significance. ASAIO J. 2020 Sep/Oct;66(9):1025-1030. doi: 10.1097/MAT.0000000000001154. PMID: 32224786.
  • Song Z, Wang C, Stammers AH. Clinical comparison of pulsatile and nonpulsatile perfusion during cardiopulmonary bypass. J ExtraCorpor Technol. 1997 Dec;29(4):170-5. PMID: 10176125.
  • Geha AS, Salaymeh MT, Abe T, Baue AE. Effect of pulsatile cardiopulmonary bypass on cerebral metabolism. J SurgRes. 1972 Jun;12(6):381-7. doi: 10.1016/0022-4804(72)90088-1. PMID: 5037460.
  • Louagie YA, Gonzalez M, Collard E, Mayné A, Gruslin A, Jamart J, Buche M, Schoevaerdts JC. Does flow character of cardiopulmonary bypass make a difference? J Thorac Cardiovasc Surg. 1992 Dec;104(6):1628-38. PMID: 1453728.
  • Adademir T, Ak K, Aljodi M, Elçi ME, Arsan S, Isbir S. The effects of pulsatile cardiopulmonary bypass on acute kidney injury. Int J ArtifOrgans. 2012 Jul;35(7):511-9. doi: 10.5301/ijao.5000097. PMID: 22466997.
  • Sezai A, Shiono M, Nakata K, Hata M, Iida M, Saito A, Hattori T, Wakui S, Soeda M, Taoka M, Umeda T, Negishi N, Sezai Y. Effects of pulsatile CPB on interleukin-8 andendothelin-1 levels. ArtifOrgans. 2005 Sep;29(9):708-13. doi: 10.1111/j.1525-1594.2005.29112.x. PMID: 16143012.
  • Gu YJ, vanOeveren W, Mungroop HE, Epema AH, den Hamer IJ, Keizer JJ, Leuvenink RP, Mariani MA, Rakhorst G. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients under going cardiacsurgery. ArtifOrgans. 2011 Feb;35(2):E18-26. doi: 10.1111/j.1525-1594.2010.01152.x. Epub 2011 Feb 14. PMID: 21314839.
  • Baraki H, Gohrbandt B, Del Bagno B, Haverich A, Boethig D, Kutschka I. Does pulsatile perfusion improve outcome after cardiac surgery? A propensity-matched analysis of 1959 patients. Perfusion. 2012 May;27(3):166-74. doi: 10.1177/0267659112437419. Epub 2012 Feb 6. PMID: 22312012.
  • Serraino GF, Marsico R, Musolino G, Ventura V, Gulletta E, Santè P, Renzulli A. Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves organ function and reduces endothelial activation. Circ J. 2012;76(5):1121-9. doi: 10.1253/circj.cj-11-1027. Epub 2012 Mar 7. PMID: 22447003.
  • Onorati F, Esposito A, Comi MC, Impiombato B, Cristodoro L, Mastroroberto P, Renzulli A. Intra-aortic balloon pump-induced pulsatile flow reduces coagulative and fibrinolytic response to cardiopulmonary bypass. ArtifOrgans. 2008 Jun;32(6):433-41. doi: 10.1111/j.1525-1594.2008.00563.x. Epub 2008 Apr 16. PMID: 18422802.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Kalp ve Damar Cerrahisi
Bölüm Araştırma Makaleleri
Yazarlar

Özkan Sönmez 0000-0001-9617-8046

Duygu Durmaz 0000-0001-9617-8046

Sedat Gündöner 0000-0002-0513-8581

Başol Bay 0000-0001-6711-0747

Yayımlanma Tarihi 22 Aralık 2023
Gönderilme Tarihi 5 Aralık 2023
Kabul Tarihi 18 Aralık 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 3 Sayı: 3

Kaynak Göster

Vancouver Sönmez Ö, Durmaz D, Gündöner S, Bay B. Kalp Cerrahisinde Pulsatil ve Nonpulsatil Akımların Preoperatif ve Postoperatif Etkilerinin Karşılaştırılması. HTD / HMJ. 2023;3(3):24-8.

e-ISSN: 2791-9935