Preoperative airway obstruction as a cause of morbidity in patients undergoing mitral valve replacement

Abstract

-mail: anesthesiayten@gmail.com Başvuru Tarihi: 04.11.2017 Kabul Tarihi:22.01.2018 Kocaeli Med J 2018; 7; 1:70-76 ARAŞTIRMA MAKALESİ/ ORIGINAL ARTICLE 71 INTRODUCTIONToday, cost analyses for coronary artery bypass and valve surgery have gained more importance. Duration of intensive care unit (ICU) and hospital stay of patients is among the main factors determining the cost of treatment. Although patients undergo similar surgical procedures and are monitored in the same unit, the duration of ICU and hospital stay may vary. Concomitant diseases of patients should be carefully evaluated and treated, then the treatment costs of patients who undergo coronary bypass and valve surgery can be reduced (1). It is of primary importance to predefine risk factors that trigger such conditions such as prolonged intubation and ICU stay, which may affect the cost.Several studies have revealed that as a systemic disease, chronic obstructive pulmonary disease (COPD) is an important risk factor in patients undergoing valve and coronary surgery (2,3). Specified risk scoring methods also indicate that COPD is a risk factor in surgical procedures (4).It is essential that preoperative risk factors are assessed with additional tests and supported with additional treatments. There may be differences in clinical studies since duration of postoperative intubation and ICU stay in coronary bypass and valve surgery depends on multiple interrelated factors. The aim of the present study is to reveal the relationship between postoperative morbidity and preoperative airway obstruction determined by preoperative assessment in patients undergoing mitral valve replacement, and to present the importance of preoperative assessment. METHODSFollowing the Ethics Committee approval of our University, we included 62 consecutive patients who underwent mitral valve replacement. We recorded the presence of airway obstruction diagnosed in the preoperative period. All patients' sex, presence of systemic disease and smoking history were recorded. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and mid-expiratory flow (MEF) 25-75% values were recorded in spirometric measurements (ZAN 100 Pulmonary Spirometer, Colorado, USA). Echocardiography values were performed using GE-VingMed Vivid S5 Echo Doppler Ultrasound. Ejection fraction (EF), systolic pulmonary artery pressure (sPAP), degree of mitral regurgitation (MR) and tricuspid regurgitation (TR) were recorded. Durations of preoperative cardiopulmonary bypass (CPB) and aortic crossclamp (XCL) were recorded. Duration of intubation and length of ICU stay were also recorded. Preoperative and postoperative aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine and blood gas values (pH, carbon dioxide (CO2), oxygen (O2), hematocrit and glucose) were recorded using the Cobas 6000 analyzer series.Patients who underwent only mitral valve replacement were considered as single-operation patients, while patients who underwent corona...