Biliflet Prolapsusu Olan Hastalarda Mitral Kapak Tamirinin Postoperatif Sonuçları

Year 2023, , 154 - 161, 30.04.2023

Eren Günertem , Ömer Faruk Çiçek , Serkan Mola , Ersin Kadirogulları , Halil İbrahim Erkengel , Adnan Yalçınkaya , Adem İlkay Diken , Emre Yaşar , Garip Altintas , Mahmut Ulaş , Gökhan Lafçı

https://doi.org/10.54005/geneltip.1217843

Abstract

Giriş
Günümüzde mitral kapak onarım teknikleri, özellikle dejeneratif hastalığı olan hastalarda neredeyse tamamen mitral kapak replasmanının yerini almaktadır. Cerrahların çoğu biliflet prolapsusu olan hastalarda onarımı tercih etmekten çekinmektedir. Bu çalışmada mitral kapak yetmezliği olan ve biliflet prolapsusu nedeniyle onarım teknikleri ile tedavi edilen hastalarımızın ameliyat sonrası sonuçlarını araştırmayı amaçladık.
Metodlar
Bu çalışmaya Ocak 2006-Ocak 2016 tarihleri arasında Türkiye Yüksek İhtisas Hastanesi'nde biliflet prolapsus nedeniyle aynı cerrahi ekip tarafından mitral kapak tamiri yapılan 89 hasta dahil edildi. Mortalite, tekrarlayan mitral yetmezlik, ekokardiyografik parametreler ve tekrar operasyon oranları gibi preoperatif, operatif ve postoperatif veriler araştırıldı.

Bulgular
Ortalama takip süresi 25,3±17,7 aydı. Ortalama yaş 46,6±17,4 idi. Transtorasik ekokardiyografik değerlendirmelere göre 8 (%9) hastada orta, 81 (%91) hastada ciddi mitral yetmezlik vardı. Preoperatif ve postoperatif değerler karşılaştırıldığında, NYHA sınıflamasına göre hastaların fonksiyonel kapasitelerinde istatistiksel olarak anlamlı iyileşme kaydedilmiştir. (2,1±0,5 ; 1, , p=0,001) Sol ventrikül diyastol sonu çapında (5,5±0,7 cm ; 5±0,6 cm, p=0,001), sol ventrikül sistol sonu çapında (3,8±0,6 cm ; 3,6±0,6 cm, p=0,004), sol atriyum çapı (4,8±0,9 cm; 4,3±0,6 cm, p=0,001) ve pulmoner arter basıncındaki (44,3±13,4 mmHg; 32,1±5,4 mmHg, p=0,001) düzelemeler istatistiksel olarak anlamlıydı.

Sonuç
İyi postoperatif sonuçlar ve dayanıklılık oranları göz önünde bulundurularak, özellikle sütür teknolojilerindeki gelişmelerle mümkün olabilen korda replasman tekniği ile bileaflet prolapsusa bağlı mitral kapak yetmezliği olan hastalarda mitral kapak onarımı güvenle kullanılabilir.

Keywords

mitral kapak, tamir, biliflet prolapsus

Postoperative Outcomes of Mitral Valve Repair in Patients with Bileaflet Prolapse

Abstract

Background
Today, repair techniques almost completely take place of the mitral valve replacement, especially in patients with degenerative disease. Majority of the surgeons hesitate to prefer repair in patients with bileaflet prolapse. In this study we aimed to investigate postoperative results of our patients with mitral valve insufficiency due to bileaflet prolapse and treated with repair techniques

Methods
89 patients who underwent mitral valve repair by the same surgical team due to bileaflet prolapse, between January 2006 and January 2016 in Turkiye Yuksek Ihtisas Hospital were included to this study. Preoperative, operative and postoperative data such as mortality, recurrent mitral insufficiency, echocardiographic parameters and reoperation rates were investigated.

Results
Mean follow up duration was 25.3±17.7 months. Mean age was 46.6±17.4 years. According to the transthoracic echocardiographic evaluations, 8 (9%) patients had moderate and 81 (91%) patients had severe mitral insufficiency. When preoperative and postoperative values were compared statistically significant improvement in functional capacity of patients according to NYHA classification has been noted. (2.1±0.5 ; 1, , p=0.001) Improvements in left ventricular end diastolic diameter (5.5±0.7 cm ; 5±0.6 cm, p=0.001), left ventricular end sistolic diameter (3.8±0.6 cm ; 3.6±0.6 cm, p=0.004 ), left atrium diameter (4.8±0.9 cm ; 4.3±0.6 cm, p=0.001) and pulmonary artery pressure (44.3±13.4 mmHg; 32.1±5.4 mmHg, p=0.001) were statistically significant.
Conclusions
In the lights of findings about good postoperative results and durability rates, mitral valve repair can be safely used in patients with mitral valve insufficiency due to bileaflet prolapse especially with chordae replacement technique which can be feasible after improvements in suture technologies.

Keywords

mitral valve, repair, bileaflet prolapse

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