The results of long-term follow-up of the patients who had open heart surgery in Adnan Menderes University Cardiovascular Surgery Clinic between 1999 and 2006 years

OBJECTIVE: Open heart surgery has become a widespread treatment modality of heart diseases following the introduction of heart lung machine in 1955 throughout the world as well as in Turkey. Siyami Hersek Hospital in Istanbul, Yüksek İhtisas Hospital and Hacettepe University Hospital in Ankara are the pioneering centers for open heart surgery in our country in the 1960s. It was mid-1990s for Aydın, when open heart surgery started . First open heart operation was performed in Aydın Devlet Hospital, however it did not continue after a couple of surgeries were done. In Adnan Menderes University Hospital, first open heart surgery case was performed in 1999 and has been a routine surgical treatment of patients since then without any interference. The first open heart surgery series of patients operated in Adnan Menderes University is the mainstay of development of cardiac surgery in Aydın. The main purpose of this study is to investigate the early and long-term results of these patients. There is lack of information for the long-term results of patients who underwent open heart surgery in Turkey and this study contributes to fullfil this lack of information. METHOD: The first 253 consecutive patients who had open heart surgery in Cardiovascular Surgery Clinic at Adnan Menderes University in Aydın were included in the study. The long-term results of 240 patients who were discharged from hospital were analyzed. The end-points of the study were death, re-angiography, re-operation and functional capacity status of patients at the time of follow-up. All of the data was complete for each one of 253 consequtive patient. Information was gathered from patient files and patients were either invited for out-patient examination or information was taken through phone conversation. Data from civil registry was also checked. The survival of patients acording to type of operation is analysed by Kaplan-Meier survival test. Chi square test, Fischer?s square test, Student?s test and Mann-Whitney U test and Wilcoxon test were used for evaluation of re-angiography and re-operation rates where appropriate. RESULTS: The first open heart surgery case in Adnan Menderes University was closure of atrial septal defect in 38 years old woman on 22 November 1999. Until the end of the 2003, there were 253 patients who had open heart surgery consecutively. There were 61 women, 192 men. Mean age was 59 years old, ranging from 14 to 89 years. Seventy three percent of patients had coronary artery disease , 22% had heart valve disease, 4% had congenital heart defects , 3% of patients had aortic dissection and aneurysms of the aorta. Hospital mortality was % 5,2. Types of surgery were coronary artery bypass grafting (CABG) (70%), heart valve surgery (19%) , replacement of ascending aorta for acute aortic dissection (2%), correction of congenital heart defects in the adult (4%), heart valve surgery combined with CABG (3%), aortic valve replacement combined with replacement of ascending aorta (1%). Follow-up was complete for all 240 patients who were discharged from the hospital. Total follow-up was 26170 patient months ranging from one month to 168 months. Ten year survival was 80% for all patients. It was 83% for men and 77% for women (p>0.05). Ten year survival was 85 % for isolated CABG patients. For patients who had isolated heart valve surgery, 10 year survival rate was 70%. Ten yer survival was lowest in patients who had combined CABG and heart valve surgery (p<0.05). Re-operation rate was 1.2%. Re-angiography rate was 8.7%. There was no difference in re-angiography rates acoording to age of the patient, gender and number of distal anastomosis. Funtional status at the time of follow-up was NYHA class 1 or 2 in 96% of surviving patients. Eighty-one percent of surviving patients who had CABG surgery was angina free at the time of follow-up. CONCLUSION: These are the results of first open heart surgery series in Aydın. The results of long-term follow-up of the first consecutive 253 patients who had open heart surgery in Adnan Menderes University showed that survival rates of these patients are similar to those reported from heading cardiac centers worldwide. The functional status of surviving patients at the time of follow-up showed that great majority of patients are symptom free. It is believed that these remarkable results of first series of open heart surgery patients play major role in progress of cardiac surgery in Aydın.