Veysel BAŞAR, Mehmed YANARTAŞ, Serkan GÜME

Mitral Anüler Kalsifikasyonu Olup Mitral Kapak Replasmanı Yapılan Hastaların Postoperatif Orta Dönem Sonuçlarının Değerlendirilmesi

Giriş: Mitral anüler kalsifikasyon (MAK), mitral kapağı çevreleyen fibröz dokunun kalsifikasyonuyla karakterize kronik dejeneratif noninflamatuvar bir durumdur. MAK (+) olup mitral kapak replasmanı (MVR) yapılan hastalarda protez kapak dehissensi, atriyoventriküler oluk ayrışması gibi durumlar görülebilir. Bu çalışmada, MAK (+) olup MVR yapılmış hastaların kendi arasında postoperatif dönemdeki paravalvüler kaçak (PVL) oranlarını, komplikasyonlarını, mortalite ve morbiditeyi azaltmak için intraoperatif/postoperatif ne gibi önlemler alınabileceğinin araştırılması amaçlanmıştır. Hastalar ve Yöntem: 2014 Ocak ile 2017 Aralık arasında kliniğimizde, MAK olup MVR yapılmış olan hastalar retrospektif olarak incelendi. Hastalar, MVR ile birlikte triküspit kapağa müdahale edilen (Grup 1, n= 26, %56.5) ve MVR ile triküspit kapağa müdahale ve ek kardiyak prosedür uygulanan hastalar (Grup 2, n= 20, %43.4) olmak üzere iki gruba ayrıldı. Bu hastalara ait preoperatif, operatif ve postoperatif sonuçlar karşılaştırıldı. Bulgular: Çalışma 16 erkek (%34.8) ve 30 kadın (%65.2), toplam 46 hasta üzerinde yapılmıştır. Hastaların ortalama yaşı 62 ± 11.6 yıldır. İntraoperatif verilere bakıldığında; Grup 2’de kros klemp süresi ve kardiyopulmoner baypas süresi Grup 1’e göre anlamlı olarak daha uzun bulunmuştur (p< 0.001). Postoperatif dönemde Grup 2’de postoperatif sıfırıncı gün ve toplam drenaj miktarı, kan ürünü ihtiyacı, postoperatif akut böbrek yetmezliği gelişimi ve hemodiyaliz/hemofiltrasyon ihtiyacı, ECMO ve inotrop gereksinimi anlamlı olarak daha yüksek bulunmuştur. Postoperatif ekokardiyografi verilerinde ise iki grup arasındaki PVL oranları arasında anlamlı fark saptanmamıştır. Sonuç: Mitral anüler kalsifikasyon olup MVR ile birlikte ek prosedür yapılan hastalarda MVR yapılan hastalara göre kros klemp süresi ve kardiyopulmoner baypas süresi daha yüksek saptanmış olup bu grupta postoperatif dönemde daha fazla komplikasyon görülmüştür. Ek cerrahi prosedürlerin PVL ve mortalite oranları üzerine etkisi yoktur.

Evaluation of Postoperative Mid-Term Outcomes of Patients with Mitral Annular Calcification Undergoing Mitral Valve Replacement

Introduction: Mitral annular calcification (MAC) is a chronic degenerative condition characterized by calcification of the fibrous tissue surrounding the mitral valve. Conditions such as prosthetic valve dehiscence and atrioventricular groove separation may occur in patients with MAC who undergo mitral valve replacement (MVR). The aim of this study was to investigate what measures can be taken in the intraoperative/postoperative period to reduce postoperative paravalvular leak (PVL) rates, complications, mortality and morbidity rates among patients with MAC undergoing MVR. Patients and Methods: Patients with MAC undergoing MVR in our clinic between January 2014 and December 2017 were retrospectively analyzed. The patients were divided into two groups: patients undergoing MVR and tricuspid valve intervention (Group 1, n= 26, %56.5) and those undergoing MVR, tricuspid valve intervention and additional cardiac procedure (Group 2, n= 20, %43.4). Preoperative, operative and postoperative outcomes of them were compared. Results: The study included a total of 46 patients, 16 males (34.8%) and 30 females (65.2%). The mean age of patients was 62 ± 11.6. The analysis of intraoperative data showed that cross-clamp time and cardiopulmonary bypass time in Group 2 were significantly longer than other group (p< 0.001). In the postoperative period, postoperative day 0 and total drainage amount, blood product requirement, development of postoperative acute kidney injury, hemodialysis/hemofiltration requirement, and need for extracorporeal membrane oxygenation (ECMO) and inotropic treatment were found to be significantly higher in Group 2. In the postoperative echocardiography data, no significant difference was found between the two groups in terms of PVL rates. Conclusion: Cross-clamp time and cardiopulmonary bypass time were found to be higher in patients with MAC receiving both MVR and additional procedure compared to those who underwent MVR and more complications were observed in these patients. Additional surgical procedures did not affect paravalvular leak rates and mortality rates among the patients with MAC.

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