Hakkı Zafer İŞCAN, Ufuk TÜTÜN, Ertekin Utku ÜNAL, Veysel BAŞAR, Cemal Levent BİRİNCİOĞLU

İSKEMİK MİTRAL YETMEZLİKTE KAPAK REPLASMANI VE TAMİR SONUÇLARININ KARŞILAŞTIRILMASI

Amaç: İskemik kalp hastalığına bağlı gelişen mitral yetmezlik, halen operatif mortalitesi yüksek seyirli birhastalıktır. Cerrahi prosedür olarak halen bir fikir birliği sağlanmamıştır. Bu çalışmada İskemik Mitral Yetmezlikte (İMY), mitral kapak replasmanı (MVR) ve tamir sonuçlarının karşılaştırılarak, birbirlerine üstünlükleriniortaya koymak amaçlanmıştır.Materyal ve Metod: 2007 ve 2011 yılları arasında Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde,İMY nedeniyle opere edilen 36 hasta incelenmiştir. Hastaların (38.9%) kadın, 22’si (61.1%) erkekti. 20 hastaya MVR, 16 hastaya mitral rekonstrüksiyon yapıldı. Her iki grupta bütün vakalarda koroner bypass mevcuttu.Hastalarda preoperatif risk faktörleri, mitral yetersizliğin derecesi, sol ventrikül ejeksiyon fraksiyonları, prepostoperatif fonksiyonel klasifikasyonları, aort kros klemp ve kardiyopulmoner bypass süreleri, yoğun bakımve hastane kalış süreleri belirlendi.Bulgular: MVR yapılan grupta preoperatif diyastolik çap ve kontrol diyastolik çap arasında anlamlı olarak farksaptanmıştır (p=0.016). Bu grupta diyastolik çaptaki düzelme tamir grubuna göre istatistiksel olarak dahaiyi çıkmıştır. Ayrıca preoperatif fonksiyonel kapasite (FK) ve kontrol FK arasında, düzelme yönünde anlamlıfark bulunmuştur (p=0.008). Erken dönem mortalite görülen hastalar incelendiğinde MVR yapılan grupta6 hasta, tamir grubunda 5 hasta exitus oldu. Mortalite görülen 11 hasta ile sağ kalan hastalar preoperatifejeksiyon fraksiyonu (EF) yönünden karşılaştırıldığında anlamlı bir fark bulunmamıştır (p=0.986)Sonuç: İMY‘de öncelikle mitral tamir önerilse de, son zamanlarda bazı çalışmalarda da önerildiği gibi, MVRyapılması mitral yetmezliğin tam giderilmesini sağlayıp, reoperasyonriskini azaltmaktadır.

Comparison of the Surgical Results Between Valve Replacement and Repair in the Treatment of Mitral Insufficieny

Objective: Mitral insufficiency due to ischemic heart disease is still a disease with high operative mortality. There is still no consensus as surgical procedure. In this study, it is aimed to reveal the superiority of ischemic mitral insufficiency (IMI), mitral valve replacement (MVR) and repair results. Materials and Methods: 2007 and High-Turkey Training and Research Hospital between the years of 2011, 36 patients were operated for IMI was examined. The patients (38.9%) were female and 22 (61.1%) were male. MVR was performed in 20 patients and mitral reconstruction was performed in 16 patients. There was coronary bypass in all cases. Preoperative risk factors, degree of mitral regurgitation, left ventricular ejection fractions, pre-postoperative functional classifications, aortic cross clamp and cardiopulmonary bypass duration, intensive care and hospital stay were determined. Results: There was a significant difference between preoperative diastolic diameter and control diastolic diameter in the MVR group (p = 0.016). In this group diastolic diametric improvement was statistically better than the repair group. Furthermore, there was a significant difference between the preoperative functional capacity (FC) and control FC in terms of improvement (p = 0.008). When the patients with early mortality were examined, 6 patients in the MVR group and 5 patients in the repair group died. There was no significant difference between 11 patients with mortality and the survivors in terms of preoperative ejection fraction (EF) (p = 0.986). Conclusion: Although mitral repair is recommended in IMI, as recently suggested in some studies, MVR provides complete removal of mitral insufficiency and reduces the risk of reoperation.

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