Serkan MOLA, Alp YILDIRIM, Sabir HASANZADE, Gokay DENIZ, Burak KASAPOĞLU

Mitral Kapak Replasmanında Sütür Tekniklerinin Karşılaştırmalı Değerlendirilmesi: Klinik Sonuçlar Üzerindeki Etkisi

Amaç: Bu çalışmanın amacı mitral kapak replasmanında (MKR) aralıklı basit sütür tekniği ile pledgetli horizontal matriks sütür tekniğinin sonuçlarını paravalvüler kaçak ve enfektif endokardit açısından karşılaştırmaktır. Yöntemler: 2019-2023 yılları arasında MKR uygulanan 422 hasta retrospektif olarak analiz edildi. Hastalar kullanılan sütür tekniğine göre iki gruba ayrıldı: grup B (basit sütür tekniği) ve grup P (pledgetli horizontal matriks sütür tekniği). Grupları dengelemek için eğilim skoru eşleştirmesi yapıldı ve karşılaştırmalı analiz için 62 vaka çifti elde edildi. Bulgular: İntraoperatif mortalite izlenmedi ve kardiyopulmoner baypas süresi ve kros klemp süresi iki grup arasında anlamlı farklılık göstermedi. Toplam hastanede yatış süresi, hastane içi mortalite, serebrovasküler olaylar ve aritmiler açısından iki grup arasında anlamlı fark gözlenmedi. Ameliyat sonrası ekokardiyografide her iki grupta da minimal paravalvüler kaçak saptandı; B grubunda 4 hastada ve P grubunda 2 hastada ciddi olmayan kaçak gözlendi. Enfektif endokardit insidansı B grubunda 1 ve P grubunda 2 idi. Hemoliz göstergeleri istatistiksel olarak anlamlı olmasa da basit sütür tekniği grubunda daha yüksek ortalama değerler gösterdi. Sonuç: Bu çalışma, aralıklı basit sütür tekniği ile pledgetli horizontal matriks sütür tekniği arasında paravalvüler kaçak ve enfektif endokardit insidansı açısından anlamlı bir fark olmadığını gösterdi. Her iki teknik de MKR'de güvenle kullanılabilir.

Anahtar Kelimeler:

enfektif endokardit, mitral kapak replasmanı, paravalvüler kaçak, sütür tekniği

Comparative Evaluation of Suture Techniques in Mitral Valve Replacement: Impact on Clinical Outcomes

Background: This study aimed to compare the outcomes of mitral valve replacement (MVR) using the intermittent simple suture technique versus the horizontal matrix suture technique with pledgeted in terms of paravalvular leakage and infective endocarditis. Methods: A retrospective analysis was conducted on 422 patients who underwent MVR between 2019 and 2023. Patients were divided into two groups based on the suture technique used: group B (simple suture technique) and group P (horizontal matrix suture technique with pledgeted). Propensity score matching was performed to balance the groups, resulting in 62 case pairs for comparative analysis. Results: There were no intraoperative mortalities, and the duration of cardiopulmonary bypass and cross-clamp time did not significantly differ between the two groups. No significant differences were observed in terms of total hospitalization time, early mortality, cerebrovascular events, and arrhythmias. Postoperative echocardiography revealed minimal paravalvular leakage in both groups, with non-serious leakage observed in 4 patients in group B and 2 patients in group P. The incidence of infective endocarditis was 1 in group B and 2 in group P. Hemolysis indicators showed higher mean values in the simple suture technique group, although not statistically significant. Conclusions: The study findings suggest that there is no significant difference in the incidence of paravalvular leak and infective endocarditis between the intermittent simple suture technique and the horizontal matrix suture technique with pledgeted. Both techniques can be safely employed in MVR.

Keywords:

infective endocarditis, mitral valve replacement, paravalvular leak, suture technique,

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Nair SK, Bhatnagar G, Valencia O, Chandrasekaran V. Effect of valve suture technique on incidence of paraprosthetic regurgitation and 10-year survival. Ann Thorac Surg 2010;89:1171-1179.
Schoen FJ, Titus JL, Lawrie GM. Autopsy-determined causes of death after cardiac valve replacement. JAMA 1983;249:899-902.
Dhasmana JP, Blackstone EH, Kirklin JW, Kouchoukos NT. Factors associated with periprosthetic leakage following primary mitral valve replacement. With special consideration of the suture technique. Ann Surg 1983;35:170-178.
Janusz MT, Jamieson WRE, Allen P, Munro AI, Miyagishima RT, Tutassura H, et al. Experience with the Carpentier-Edwards porcine valve prosthesis in 700 patients. Ann Thorac Surg 1982;34:625-633.
Bharadwaj B, Wall R, Nytting S. Long-term follow-up of patients who underwent single valve replacement with Bjork-Shiley prosthesis. Can J Surg 1980;23:183-186.
Ionescu A, Fraser A, Butchart E. Prevalence and clinical significance of incidental paraprosthetic valvar regurgitation: a prospective study using transoesophageal echocardiography. Heart 2003;89:1316-1321.
Kloster F. Diagnosis and management of complications of prosthetic heart valves. Am J Cardiol 1975;35:872-875.
Kim GJ, Lee JT, Lee YO, Cho JY, Oh TH. Outcomes of nonpledgeted horizontal mattress suture technique for mitral valve replacement. Korean J Thorac Cardiovasc Surg 2014;47:504-509.
Genoni M, Franzen D, Tavakoli R, Seiffert B, Graves K, Jenni R, et al. Does the morphology of mitral paravalvular leaks influence symptoms and hemolysis? J Heart Valve Dis 2001;10:426-430.
Jindani A, Neville EM, Venn G, Williams BT. Paraprosthetic leak: a complication of cardiac valve replacement. J Cardiovasc Surg (Torino) 1991;32:503-508.
Englberger L, Schaff HV, Jamieson WR, Kennard ED, Im KA, Holubkov R, et al. Importance of implant technique on risk of major paravalvular leak (PVL) after St. Jude mechanical heart valve replacement: a report from the Artificial Valve Endocarditis Reduction Trial (AVERT). Eur J Cardiothorac Surg 2005;28:838-843.
Kirsh MM, Sloan H. Technique of mitral valve replacement. Ann Thorac Surg 1980;30:490-492.
Fishman NH, Hutchinson JC, Roe BB. Prevention of prosthetic cardiac valve detachment. Surgery 1970;67:867-873.
Newton JR, Glower DD, Davis JW, Scott Rankin J. Evaluation of suture techniques for mitral valve replacement. J Thorac Cardiovasc Surg 1984;88:248-252.
Mahesh B, Angelini G, Caputo M, Jin XY, Bryan A. Prosthetic valve endocarditis. Ann Thorac Surg. 2005;80:1151-1158.
Vlessis AA, Khaki A, Grunkemeier GL, Li HH, Starr A. Risk, diagnosis and management of prosthetic valve endocarditis: a review. J Heart Valve Dis 1997;6:443-465.