Ali Yaşar KILINÇ, Fulya AVCI DEMİR, Refik Emre ALTEKİN, İbrahim DEMİR, Mehdi ONAÇ, Gündüzalp SAYDAM

Transkateter Aort Kapak Replasmanı Kısa ve Orta Dönem Sonuçları: Tek Merkez Deneyimi

GİRİŞ ve AMAÇ: Ciddi aort darlığı olan semptomatik hastalar cerrahi olarak tedavi edilmelidirler. İleri yaş ve komorbiditeler sebebi ile hastaların %30’u tedavi edilememektedir. Bu amaçla transkateter aort kapak replasmanı (TAVR) geliştirilmiştir. Çalışmamızın amacı TAVR yapılan hastaların gerçek yaşam sonuçlarını yayınlamaktır. YÖNTEM ve GEREÇLER: TAVR işlemi yapılan 136 hasta retrospektif incelenmiştir. Primer sonlanım noktası perioperatif mortalite (POM), sekonder sonlanımlar postoperatif 6 ay içerisinde gelişen major adverse serebrovasküler ve kardiyovasküler olaylar (MASKO) ve postoperatif kalıcı kalp pili (KKP) ihtiyacı olarak belirlenmiştir. BULGULAR: POM gelişen hastalarda KKP, entübasyon ve kan transfüzyonu daha fazla, postoperatif hemoglobin daha düşük, postoperatif BUN, lökosit ve 48. saat kreatinin daha yüksek bulunmuştur. KKP ihtiyacı kadınlarda ve işlem sonrasında sol dal bloğu gelişen hastalarda daha fazla olmuştur. MASKO gelişen hastalarda kronik obstrüktif akciğer hastalığı, entübasyon ve transfüzyon ihtiyacı daha fazla, preoperatif CRP ile postoperatif CRP ve lökosit daha yüksek bulunmuştur. POM’ nin bağımsız risk faktörleri işlem sonrasında transfüzyon ve KKP ihtiyacı gelişmesi, MASKO risk faktörleri entübasyon ve transfüzyon ihtiyacı olması, KKP için risk faktörü kadın cinsiyet olmuştur. TARTIŞMA ve SONUÇ: Transkateter aort kapak replasmanı yüksek cerrahi risk nedeni ile operasyon yapılamayan hastalarda düşük mortalite oranı ile uygun bir tedavi seçeneğidir.

Short And Mid Term Results Of Transcatheter Aortic Valve Implantation: A Single-Center Experience

INTRODUCTION: Patients with severe aortic stenosis and symptomatic should be treated surgically. Because of advanced age and comorbidities, 30% of patients cannot be treated. For this purpose transcatheter aortic valve replacement (TAVR) procedure has been developed. The purpose of our study is to analyze real life results of patients who underwent TAVR. METHODS: 136 patients were analyzed retrospectively. Primary endpoint was perioperative mortality (POM), secondary endpoints were major adverse cardiovascular and cerebrovascular events(MACCE), developed during the6-month post-procedure period and permanent pacemaker (PPM) requirement in postoperative period. RESULTS: In patients, developed POM; PPM, transfusion and intubation requirements were higher, postoperative hemoglobin was lower, postoperative BUN, leukocyte and 48th hour creatinine were higher. PPM requirement was higher in women and patients with left bundle branch block on ECG after procedure. In patients who developed MACCE, presence of chronic obstructive pulmonary disease, intubation and transfusion requirement, preoperative CRP and postoperative CRP and leukocyte were higher. In multivariate regression analyzes, independent risk factors of POM were transfusion and PPM requirement, MACCE risk factors were intubation and transfusion requirement, and PPM risk factor was female gender. DISCUSSION AND CONCLUSION: TAVR is an appropriate treatment option with low mortality risk in patients who cannot be operated due to high surgical risk.

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