Dejeneratif Mitral Yetmezliği Olan Hastalarda Mitral Kapak Onarımının Erken ve Orta Dönem Sonuçları

Giriş: Bu çalışmada, mitral kapak tamir programımızın ilk beş yılında dejeneratif mitral kapak yetmezliği nedeniyle kapak tamiri uyguladığımız hastaların erken ve orta dönem sonuçlarını sunmak amaçlanmıştır. Hastalar ve Yöntem: Bu retrospektif çalışmada, 2013-2017 yıllarında tek cerrahi ekip tarafından dejeneratif mitral yetmezlik nedeniyle ameliyat edilen tüm hastalar incelendi. Erken ve orta dönem toplam sağkalım oranlarını, onarım başarısızlığını ve reoperasyon oranları belirlendi. Ayrıca özellikli bir alt grup olarak 18 yaş altı hastaların mitral kapak tamiri sonrası sonuçları araştırıldı. Bulgular: Çalışma süresi boyunca 153 dejeneratif mitral yetmezlik hastasının 121’inde mitral onarım yapılmıştır. Genel onarım oranı %79 idi. Takip eden yıllarda mitral kapak onarım oranı önemli ölçüde artmıştır. Medyan takip süresi 63 (10-92) aydır. Erken mortalite oranı %2.5’tir (n= 3). Takip süresi boyunca 14 (%11.8) hastada orta-şiddetli mitral yetmezlik görülmüş, 7 (%5.9) hastada mitral kapak reoperasyonu gerekmiştir. On sekiz yaş altı yedi hastanın dördünde kapak tamiri yapılmıştır. Takip süresi boyunca (medyan 46 ay) tekrar ameliyat gerektiren pediatrik olgu olmamıştır. Sonuç: Dejeneratif mitral kapak hastalarında mitral kapak onarımının orta dönem sonuçları tatmin edicidir. Cerrahi deneyime paralel olarak onarımın başarı oranı da artmaktadır.

Early and Mid-Term Results of Mitral Valve Repair in Patients with Degenerative Mitral Regurgitation

Introduction: In this study, we present the early and mid-term results of patients who underwent valve repair due to degenerative mitral valve regurgitation in the first five years of our mitral valve repair program. Patients and Methods: In this retrospective study, all patients who were operated for degenerative mitral regurgitation by a single surgical team between 2013 and 2017 were investigated. We determined early and mid-term cumulative survival rates, repair failure and freedom from reoperation. In addition, as a specific subgroup, the results of patients under 18 years of age after mitral valve repair were investigated. Results: Mitral repair was performed in 121 of 153 degenerative mitral regurgitation patients during the study period. The overall repair rate was 79%. Mitral valve repair rate increased significantly over years. The median follow-up time was 63 (range 10-92) months. Early mortality was 2.5% (n= 3). During the follow-up period, moderate-to-severe mitral regurgitation was observed in 14 (11.8%) patients, mitral valve reoperation was required in 7 (5.9%) patients. Valve repair was performed in 4 of 7 patients under the age of 18. There was no pediatric case requiring reoperation during the follow-up period (median 46 months). Conclusion: Mid-term results of mitral valve repair in degenerative mitral valve patients are satisfactory. The success rate of repair increases in line with surgical experience.

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1. Carabello BA. Mitral valve regurgitation. Curr Probl Cardiol 1998;23:202-41. [Crossref]
2. Apostolidou E, Maslow AD, Poppas A. Primary mitral valve regurgitation: Update and review. Glob Cardiol Sci Pract 2017;2017:e201703. [Crossref]
3. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation 2021;143:e35-71. [Crossref]
4. Lazam S, Vanoverschelde JL, Tribouilloy C, Grigioni F, Suri RM, Avierinos JF, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: analysis of a large, prospective, multicenter, international registry. Circulation 2017;135:410-22. [Crossref]
5. Edmunds LH, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. Eur J Cardiothorac Surg 1996;10:812-6. [Crossref]
6. Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013;14:611-44. [Crossref]
7. Enriquez-Sarano M, Schaff HV. Valve repair improves the outcome of surgery for mitral regurgitation: a multivariate analysis. Circulation 1995;91:1022-8. [Crossref]
8. Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg 2007;31:267-75. [Crossref]
9. David TE, Armstrong S, McCrindle BW, Manlhiot C. Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease. Circulation 2013;127:1485-92. [Crossref]
10. Crawford MH, Souchek J, Oprian CA, Miller DC, Rahimtoola S, Giacomini JC, et al. Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease. Circulation 1990;81:1173-81. [Crossref]
11. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129:e521-643. [Crossref]
12. Suri RM, Schaff HV, Dearani JA, Sundt TM 3rd, Daly RC, Mullany CJ, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg 2006;82:819-26. [Crossref]
13. David TE, Ivanov J, Armstrong S, Christie D, Rakowski H. A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse. J Thorac Cardiovasc Surg 2005;130:1242-9. [Crossref]
14. Weiner MM, Hofer I, Lin HM, Castillo JG, Adams DH, Fischer GW. Relationship among surgical volume, repair quality, and perioperative outcomes for repair of mitral insufficiency in a mitral valve reference center. J Thorac Cardiovasc Surg 2014;148:2021-6. [Crossref]
15. Gammie JS, Chikwe J, Badhwar V, Thibault DP, Vemulapalli S, Thourani VH, et al. Isolated mitral valve surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database analysis. Ann Thorac Surg 2018;106:716-27. [Crossref]
16. Lee C, Lee CH, Kwak JG, Park CS, Kim SJ, Song JY, et al. Long-term results after mitral valve repair in children. Eur J Cardiothorac Surg 2010;37:267-72. [Crossref]

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi