Başak SORAN TÜRKCAN, Atakan ATALAY, Ata Niyazi ECEVİT, Mustafa YILMAZ, Ahmet Vedat KAVURT, Yasemin ÖZDEMİR ŞAHAN, Gökçe SELÇUK SERT, Kanat ÖZIŞIK

ATRİOVENTRİKÜLER SEPTAL DEFEKT ONARIMI: KLASİK TEK YAMA VE ÇİFT YAMA TEKNİKLERİNİN KARŞILAŞTIRILMASI

Amaç: Komplet atriyoventriküler septal defektli pediatrik hastaların cerrahisinde genellikle farklı yama teknikleri kullanılmıştır. Bu çalışmada, komplet atriyoventriküler septal defekt onarımında klasik tek yama ve çift yama teknikleri ile ilgili tek merkezli, tek cerrah deneyimlerimiz ve sonuçlarımız anlatılmaktadır. Gereç ve Yöntem: Bu retrospektif çalışma, Ankara Bilkent Şehir Hastanesi Çocuk Kalp ve Damar Cerrahisi Kliniğinde Komplet atriyoventriküler septal defekt ile intrakardiyak onarımı yapılan 30 hastayı kapsamaktadır. Çalışma Şubat 2019 ile Aralık 2021 arasında gerçekleştirilmiştir. Grup S’deki hastalara geleneksel tek yama yöntemi ile opere edilmiştir. (n = 20) Grup D’deki hastalar ise çift yama tekniği ile opere edilmiştir.(n = 10) Hastaların demografik ve klinik bilgileri kurumsal veri tabanlarından ve tıbbi kayıtlardan alındı. Postoperatif komplikasyonlar kaydedildi. Sonuçlar: Kapakların preoperatif/postoperatif yetersizlik düzeyleri Wilcoxon Signed rank testi ile karşılaştırıldığında sol atriyoventriküler kapak için istatistiksel olarak anlamlı değilken sağ atriyoventriküler kapak için istatistiksel olarak anlamlı bulundu. (p=0,02) Her iki tekniğin postoperatif kapak yetersizliğini Kruskall-Wallis testi ile karşılaştırdığımızda, ameliyat öncesi bulgulardan bağımsız olarak postoperatif kapak yetersizliği ve fonksiyon arasında anlamlı bir fark bulunmadı. Tartışma: Her iki ameliyat tekniği de operatif veya geç mortalite ve morbidite arasında fark yaratmadı. Cerrahın tecrübesine bağlı olarak ventriküler septal defekt boyutu kullanılacak tekniğin seçiminde kısıtlayıcı bir rol oynamaz. Burada açıklanan tek yama ve çift yama yöntemi, metodik, anlaşılır, tekrarlanabilir ve oldukça uzun ömürlüdür.

Anahtar Kelimeler:

Atrioventriküler Septal Defekt, Pulmoner Hipertansiyon, Farklı tamir yöntemleri, Endokardiyal yastıkçık defektleri.

Atrioventricular Septal Defects Repair: Comparison of Classic Single Patch and Double-Patch Techniques

Objective: Different patch techniques were virtually always used in the surgery of pediatric patients with complete atrioventricular septal defects. In this study, we described our single center, single surgeon experiences and results about the classic single patch and double patch techniques to repair complete atrioventricular septal defects. Materials and Methods: This retrospective descriptive study included 30 patients who underwent intracardiac repair of complete atrioventricular septal defect in Ankara Bilkent City Hospital Department of Pediatric Cardiovascular Surgery. The study was conducted between February 2019 to December 2021. Patients in group S underwent surgery using the traditional single-patch method, while group D included patients who underwent repair using the double patch approach (n = 10). Patients’ demographic and clinical information was taken from institutional databases and medical records. Postoperative complications were recorded. Results: When the preoperative/postoperative insufficiency levels of the valves were compared with the Wilcoxon Signed rank test, the findings were not statistically significant for the left atrioventricular valves, but were statistically significant for the right atrioventricular valves. (p=0.02) When we compared postoperative valve regurgitation of both techniques with the Kruskall-Wallis test, no significant difference was found between postoperative valve regurgitation and function, independent of preoperative findings. Conclusion: Both operation techniques did not make a difference between operative or late mortality and morbidity. Depending on the surgeon’s experience, ventricular septal defect size does not play a restrictive role in the selection of the technique to be used. The single-patch and double patch method as described here is methodical, comprehensible, repeatable, and reasonably long-lasting.

Keywords:

Atrioventricular septal defect repair, pulmonary hypertension, different techniques for repair, endocardial cushion defects.,

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