ÖZET

Amaç:

Sol ventrikül destek cihazı cerrahisi (LVAD) ile ilişkili akut böbrek hasarı (ABH), %15-45 insidans ile kalp cerrahisinin ciddi bir komplikasyonudur. Çalışma, LVAD cerrahisi sonrası erken dönemde ABH’yi Böbrek Hastalığı: Küresel Sonuçların İyileştirilmesi (KDIGO) kriterlerini kullanarak değerlendirmeyi ve ABH olan ve olmayan hastaları insidans, risk faktörleri ve klinik sonuçları belirlemek için karşılaştırmayı amaçladı.

Gereç ve Yöntem:

Bu retrospektif kohort çalışmada, Ocak 2011 ile Aralık 2016 arasında LVAD implantasyonu uygulanan 18-75 yaş arasındaki tüm hastaların tıbbi kayıtları gözden geçirildi. Hastalar, demografik özellikleri ve perioperatif değişkenleri analiz etmek için ABH gelişimine göre iki gruba ayrıldı. ABH, KDIGO kriterlerine göre tanımlandı.

Bulgular:

Elli yedi hastanın 10’u (%18) kadındı ve ortalama yaş 44,6±16,1 yıldı. Otuz altı hastada (%63) LVAD implantasyonunu takiben ABH gelişti. Lojistik regresyon analizi, ABH için bağımsız risk faktörleri olarak postoperatif birinci günde kardiyopulmoner bypass süresi, ortalama kan basıncı ve kümülatif sıvı dengesini ortaya koydu [olasılık oranı (OR): 1.013, güven aralığı (GA) %95 1,000-1,025, p=0,05; OR: 0,929, GA %95 %0,873-0,989, p=0,02; OR: 1,001, GA %95 1,000-1,001, p=0,04]. ABH’li hastalarda hastane mortalitesi (%58’e karşı %24, p=0,01) ve 30 günlük mortalite (%39’a karşı %5, p=0,01) anlamlı olarak daha yüksekti.

Sonuç:

Sonuçlarımız, LVAD cerrahisi sonrası hastaların %63’ünde ABH geliştiğini göstermektedir. ABH oluşumu için risk faktörleri, uzun kardiyopulmoner bypass süresini, daha düşük ortalama kan basınçlarını ve postoperatif ilk gün daha yüksek kümülatif sıvı dengesini içerir. Bu nedenle ABH, LVAD’den sonra en önemli morbidite ve mortalite nedenlerindendir.

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Sol Ventrikül Destek Cihazı Sonrası Akut Böbrek Hasarının İnsidansı ve Risk Faktörleri

ÖZET

References