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Kardiyak Travmada Cerrahi Tedavi Deneyimi: Tek Merkezli Çalışma

Year 2022, Volume: 24 Issue: 2, 295 - 302, 31.08.2022

Semih Murat Yücel Fatih Çalışkan

https://doi.org/10.24938/kutfd.1097513

Abstract

Amaç: Kardiyak travma yüksek mortalite oranına sahiptir ve acil tanı ve cerrahi tedavi gerektirir. Bu retrospektif çalışma, kardiyak travma nedeniyle acil cerrahi tedavi uygulanan hastaların sonuçlarını kardiyak yaralanma skor sistemleri kullanılarak değerlendirmek amacıyla planlandı.
Gereç ve Yöntemler: Ocak 1985-Kasım 2021 tarihleri arasında acil servisimize başvuran ve kardiyak travma nedeniyle cerrahi operasyon geçiren tüm travmalı hastalar retrospektif olarak incelendi. Perkütan girişim sonrası iyatrojenik kalp travması gelişen hastalar da çalışma popülasyonuna dahil edildi. Tüm hastalarda fizyolojik indeks (PI), penetran kardiyak travma indeksi (PCTI), penetran torasik travma indeksi (PTTI) ve American Association for the Surgery of Trauma Organ Injury Ölçeği (AAST/OIS) gibi kardiyak yaralanma ölçekleri ile klinik şiddet hesaplandı.
Bulgular: Çalışmada 39 hasta yer aldı. Hastaların 24’ünde (%61.6) penetran, 13’ünde (%33.3) iyatrojenik, 2’sinde (%5.1) künt kalp yaralanması vardı. Hastaların 15’inde (%38.5) delici bıçak yarası, 9’unda (%23.1) ateşli silah yaralanması vardı. Hastaların yaş ortalaması 48.3±19.0 (min: 6-maks: 87) /yıl ve %79.6’sı erkekti. En sık yaralanan kalp boşlukları sırasıyla sağ ventrikül (RV) (%46.2), sol ventrikül (LV) (%25.6), sağ atriyum (RA) (%10.3) ve koroner arterler (%10.3) idi. Kardiyak tamponadlı hasta sayısı 25 (%64.1) iken, 6 (%15.4) hastada ek karın yaralanması tespit edildi. Kardiyak tamponadlı hastaların %80’i hayatta kaldı (p=0.006). Bu çalışmada mortalite oranı, penetran yaralanmalar için %35 olarak bulunmuştur.
Sonuç: Çalışmamızın verileri, mortalite üzerine kardiyak tamponadın negatif etkisi olduğunu göstermekle birlikte sağ ve sol ventrikül yaralanmasının mortalite açısından karşılaştırmasında istatistiksel bir fark göstermemiştir. Çalışma sonuçlarımız, sol ventrikül yaralanmalarının daha yüksek mortalite gösterdiği şeklindeki eski görüşü de desteklememektedir.

Keywords

kardiyak yaralanma şiddet indeksi Kalp yaralanmaları cerrahi penetran künt

References

  • 1. Kulshrestha P, Iyer K, Das B, Balram A, Kumar AS, Sharma M et al. Chest injuries: A clinical and autopsy profile. J Trauma. 1988;28(6):844-7.
  • 2. Özkaynak B, Gümüş F, Polat A, Kayalar N, Erentuğ V. Cardiac trauma. JAREM. 2014;4(2):45-48.
  • 3. Oakland C, Vivian J. Penetrating cardiac injuries. Br Med J (Clin Res Ed). 1987;295(6596):502.
  • 4. Blatchford JW. Ludwig Rehn: the first successful cardiorrhaphy. Ann Thorac Surg. 1985;39(5):492-5.
  • 5. Tokcan A, Yalınız H. Kalp yaralanmaları arşivi. Arşiv Kaynak Tarama Dergisi. 2003;12(3):260-8.
  • 6. Keçeligil HT, Bahcivan M, Demirağ MK, Çelik S, Kolbakir F. Principles for the treatment of cardiac injuries: a twenty-two-year experience. Ulus Travma Acil Cerrahi Derg. 2009;15(2):171-5.
  • 7. Göz M, Çakır Ö, Eren MN. Penetrating cardiac injuries: analysis of the mortality predictors. Ulus Travma Acil Cerrahi Derg. 2009;15(4):362-6.
  • 8. Asensio JA, Stewart BM, Murray J, Fox AH, Falabella A, Gomez H et al. Penetrating cardiac injuries. Surg Clin North Am. 1996;76(4):685-724.
  • 9. Aksöyek A, Tütün U, Babaroğlu S, Parlar AI, Ulus AT, Katircioğlu SF. Penetrating cardiac injuries. Ulus Travma Acil Cerrahi Derg. 2007;13(2):135-41.
  • 10. Ivatury R, Nallathambi MN, Rohman M, Stahl W. Penetrating cardiac trauma. Quantifying the severity of anatomic and physiologic injury. Annals Surg. 1987;205(1):61-6.
  • 11. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Shackford SR, Champion HR et al. Organ injury scaling. Surg Clin North Am. 1995;75(2):293-303.
  • 12. Karasu S, Tokat AO, Uzun HA, Kısacık E, Barlas AM, Baran NT. Penetrating cardiac injuries. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2010;63(4):115-8.
  • 13. Campbell N, Thomson S, Muckart D, Meumann C, Van Middelkoop I, Botha J. Review of 1198 cases of penetrating cardiac trauma. Br J Surg. 1997;84(12):1737-40.
  • 14. Gao J, Gao Y, Wei G, Liu G, Tian X, Hu P et al. Penetrating cardiac wounds: principles for surgical management. World J Surg. 2004;28(10):1025-9.
  • 15. Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A et al. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998;44(6):1073-82.
  • 16. Buckman Jr RF, Badellino MM, Mauro LH, Asensio JA, Caputo C, Gass J et al. Penetrating cardiac wounds: prospective study of factors influencing initial resuscitation. J Trauma. 1993;34(5):717-25.
  • 17. Ceviker K, Tulay C, Sahinalp S, Atlı HF. Factors affecting mortality in cardiac injury of penetrating thorax trauma: a retrospective study. Gaziantep Med J. 2014;20(1):35-41.
  • 18. Moreno C, Moore EE, Majure JA, Hopeman AR. Pericardial tamponade: a critical determinant for survival following penetrating cardiac wounds. J Trauma. 1986;26(9):821-5.

EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY

Year 2022, Volume: 24 Issue: 2, 295 - 302, 31.08.2022

Semih Murat Yücel Fatih Çalışkan

https://doi.org/10.24938/kutfd.1097513

Abstract

Objective: Cardiac trauma has a high mortality rate and requires emergency diagnosis and surgical treatment. This retrospective study was planned to evaluate outcomes of patients who underwent urgent surgical treatment for cardiac trauma using valuable injury scoring systems.
Material and Methods: All traumatic patients who applied to our emergency service and performed surgical operations due to cardiac trauma between January 1985 and November 2021 by cardiovascular surgeons, were analyzed retrospectively. The patients with iatrogenic cardiac trauma after the percutaneous intervention were also included in the study population. Cardiac injury scales such as physiological index (PI), penetrating cardiac trauma index (PCTI), penetrating thoracic trauma index (PTTI), and American Association for the Surgery of Trauma/Organ Injury Scale (AAST/OIS), were calculated in all patients for clinical severity.
Results: In this study, 39 patients were enrolled. 24 patients (61.6%) had penetrating, 13 (33.3%) iatrogenic, 2 (5.1%) blunt cardiac injuries. 15 patients (38.5%) had penetrating stab wounds, and 9 (23.1%) had gunshot wounds. The mean age of the patients was 48.3±19.0 (min: 6-max: 87) years, and 79.6% were male. The most frequently injured cardiac chambers were right ventricle (RV) (46.2%), left ventricle (LV) (25.6%), right atrium (RA) (10.3%), and coronary arteries (10.3%), respectively. While the number of patients with cardiac tamponade was 25 (64.1%), additional abdominal injuries were detected in 6 (15.4%) patients. 80% of the patients with cardiac tamponade survived (p=0.006). The mortality rate was 35% for penetrating injuries in this study.
Conclusion: This study, which included patients with cardiac trauma from a single-center, draws attention in terms of showing the negative effect of cardiac tamponade on mortality. Our study outcomes also do not support the old dictum that left ventricular injuries have higher mortality.

Keywords

Heart injuries surgery cardiac injury severity index penetrating blunt

References

  • 1. Kulshrestha P, Iyer K, Das B, Balram A, Kumar AS, Sharma M et al. Chest injuries: A clinical and autopsy profile. J Trauma. 1988;28(6):844-7.
  • 2. Özkaynak B, Gümüş F, Polat A, Kayalar N, Erentuğ V. Cardiac trauma. JAREM. 2014;4(2):45-48.
  • 3. Oakland C, Vivian J. Penetrating cardiac injuries. Br Med J (Clin Res Ed). 1987;295(6596):502.
  • 4. Blatchford JW. Ludwig Rehn: the first successful cardiorrhaphy. Ann Thorac Surg. 1985;39(5):492-5.
  • 5. Tokcan A, Yalınız H. Kalp yaralanmaları arşivi. Arşiv Kaynak Tarama Dergisi. 2003;12(3):260-8.
  • 6. Keçeligil HT, Bahcivan M, Demirağ MK, Çelik S, Kolbakir F. Principles for the treatment of cardiac injuries: a twenty-two-year experience. Ulus Travma Acil Cerrahi Derg. 2009;15(2):171-5.
  • 7. Göz M, Çakır Ö, Eren MN. Penetrating cardiac injuries: analysis of the mortality predictors. Ulus Travma Acil Cerrahi Derg. 2009;15(4):362-6.
  • 8. Asensio JA, Stewart BM, Murray J, Fox AH, Falabella A, Gomez H et al. Penetrating cardiac injuries. Surg Clin North Am. 1996;76(4):685-724.
  • 9. Aksöyek A, Tütün U, Babaroğlu S, Parlar AI, Ulus AT, Katircioğlu SF. Penetrating cardiac injuries. Ulus Travma Acil Cerrahi Derg. 2007;13(2):135-41.
  • 10. Ivatury R, Nallathambi MN, Rohman M, Stahl W. Penetrating cardiac trauma. Quantifying the severity of anatomic and physiologic injury. Annals Surg. 1987;205(1):61-6.
  • 11. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Shackford SR, Champion HR et al. Organ injury scaling. Surg Clin North Am. 1995;75(2):293-303.
  • 12. Karasu S, Tokat AO, Uzun HA, Kısacık E, Barlas AM, Baran NT. Penetrating cardiac injuries. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2010;63(4):115-8.
  • 13. Campbell N, Thomson S, Muckart D, Meumann C, Van Middelkoop I, Botha J. Review of 1198 cases of penetrating cardiac trauma. Br J Surg. 1997;84(12):1737-40.
  • 14. Gao J, Gao Y, Wei G, Liu G, Tian X, Hu P et al. Penetrating cardiac wounds: principles for surgical management. World J Surg. 2004;28(10):1025-9.
  • 15. Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A et al. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998;44(6):1073-82.
  • 16. Buckman Jr RF, Badellino MM, Mauro LH, Asensio JA, Caputo C, Gass J et al. Penetrating cardiac wounds: prospective study of factors influencing initial resuscitation. J Trauma. 1993;34(5):717-25.
  • 17. Ceviker K, Tulay C, Sahinalp S, Atlı HF. Factors affecting mortality in cardiac injury of penetrating thorax trauma: a retrospective study. Gaziantep Med J. 2014;20(1):35-41.
  • 18. Moreno C, Moore EE, Majure JA, Hopeman AR. Pericardial tamponade: a critical determinant for survival following penetrating cardiac wounds. J Trauma. 1986;26(9):821-5.
There are 18 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Semih Murat Yücel 0000-0002-8077-828X

Fatih Çalışkan 0000-0001-7786-3929

Publication Date August 31, 2022
Submission Date April 3, 2022
Published in Issue Year 2022 Volume: 24 Issue: 2

Cite

APA Yücel, S. M., & Çalışkan, F. (2022). EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 24(2), 295-302. https://doi.org/10.24938/kutfd.1097513
AMA Yücel SM, Çalışkan F. EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY. Kırıkkale Uni Med J. August 2022;24(2):295-302. doi:10.24938/kutfd.1097513
Chicago Yücel, Semih Murat, and Fatih Çalışkan. “EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24, no. 2 (August 2022): 295-302. https://doi.org/10.24938/kutfd.1097513.
EndNote Yücel SM, Çalışkan F (August 1, 2022) EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24 2 295–302.
IEEE S. M. Yücel and F. Çalışkan, “EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY”, Kırıkkale Uni Med J, vol. 24, no. 2, pp. 295–302, 2022, doi: 10.24938/kutfd.1097513.
ISNAD Yücel, Semih Murat - Çalışkan, Fatih. “EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 24/2 (August 2022), 295-302. https://doi.org/10.24938/kutfd.1097513.
JAMA Yücel SM, Çalışkan F. EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY. Kırıkkale Uni Med J. 2022;24:295–302.
MLA Yücel, Semih Murat and Fatih Çalışkan. “EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 24, no. 2, 2022, pp. 295-02, doi:10.24938/kutfd.1097513.
Vancouver Yücel SM, Çalışkan F. EXPERIENCE OF SURGICAL TREATMENT FOR CARDIAC TRAUMA: A SINGLE-CENTERED STUDY. Kırıkkale Uni Med J. 2022;24(2):295-302.
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