Rezan AKSOY, Emre SELÇUK, Ayhan KÜP, Deniz ÇEVİRME, Üzeyir YILMAZ, Veysel BAŞAR, Furkan BALCI, Murat Bülent RABUŞ

Mitral Kapak Replasmanına Eşlik Eden Triküspid Annuloplasti Kalıcı Pacemaker İhtiyacını Arttırır mı?

Giriş: Bu çalışmada, mitral valve replasmanı (MVR) ile birlikte triküspid annuloplasti (TAP) ve izole MVR sonrası kalıcı pacemaker implantasyonu (KPI) sıklığı karşılaştırılmıştır. Hastalar ve Yöntem: Bu retrospektif çalışmada, Ocak 2015 tarihinden Mayıs 2020 tarihine kadar TAP ile birlikte MVR veya TAP olmadan MVR uygulanan 409 hasta analiz edilmiştir. Hastalar izole MVR ve MVR + TAP olarak iki gruba ayrılmıştır. İki grup KPI olup olmamasına göre karşılaştırılmıştır. Bulgular: Çalışmada toplam 409 ardışık hasta [izole MVR grubu: 212 hasta, 129 (%60.8)’u kadın, MVR + TAP grubu: 197 hasta, 138 (%70.1)’i kadın] değerlendirilmiştir. Kadın hasta sayısı, fonksiyonel mitral yetmezliği ve biyoprotez kapak kullanımı MVR + TAP grubunda daha yüksek bulunmuştur (p< 0.01). Toplam 8 (%2) hastanın KPI’ya ihtiyacı olmuştur. İki grup arasında KPI açısından istatistiksel olarak anlamlı bir fark tespit edilmemiştir (p> 0.01). Romatizmal etiyolojisi olan hastalar için postoperatif KPI sıklığı %2.2 (311 hastanın yedisi), romatizmal olmayan etiyolojisi olan hastalar için %1.1 (98 hastadan biri) olarak saptanmıştır (OR= 2.026, %95 CI= 0.24-16.68, p= 0.5). Ortalama implantasyon süresi yedi gün olarak belirlenmiştir (minimum postoperatif beşinci gün, maksimum postoperatif 45. gün). Sonuç: İzole MVR düşünüldüğünde ve hastada triküspit yetmezliği varsa, triküspit yetmezliğinin hastanın yaşam kalitesine önemli bir yük getireceği için TAP’ın kaçınılmaz olacağı açıktır. Son çalışmalar, sol kapak cerrahisine eşlik eden TAP sonrası değişen sıklıklarda KPI bildirmişlerdir. Bu çalışmada, izole MVR’ye kıyasla TAP eşliğinde MVR sonrası KPI kullanımında artış gözlemlenmiştir.

Does Concomitant Tricuspid Annuloplasty Increase the Need for Permanent Pacemaker Implantation Following Mitral Valve Replacement?

Introduction: This study compared the frequency of permanent pacemaker implantation (PPI) following mitral valve replacement (MVR) with tricuspid annuloplasty (TAP) and isolated MVR. Patients and Methods: This retrospective study analysed 409 patients who had undergone MVR with or without concomitant TAP, from January 2015 through May 2020. Patients were divided into two groups (the isolated MVR group and the MVR plus TAP group). The two groups were compared according to whether PPI was present or not. Results: A total of 409 consecutive patients [in the isolated MVR group, n= 212 patients; 129 (60.8%) female and in the MVR plus TAP group, n= 197 patients; 138 (70.1%) female] were assessed. The number of female, functional mitral regurgitation, mixed mitral disease, and the use of bio-prosthetic valve was higher in the MVR plus TAP group (p< 0.01). A total of 8 (2%) patients needed a PPI. There was no statistically significant difference between the two groups in terms of PPI (p> 0.01). The frequency of postoperative PPI was 2.2% (7 of 311 patients) in patients with rheumatic etiology and 1.1% (1 of 98 patients) in patients with non-rheumatic etiology (OR: 2.026, 95% CI: 0.24-16.68, p= 0.5). The median time to implantation was seven days [minimum postoperative days (POD) 5 , maximum POD 45]. Conclusion: When isolated MVR is considered and if the patient also has tricuspid regurgitation (TR), it is apparent that TAP will be inevitable, because TR inflicts a considerable burden on the patient’s quality of life. Recent studies reported varying frequencies of PPI after TAP accompanying left valve surgery. The present study observed no increase in the use of PPI after MVR accompanied by TAP as compared with isolated MVR.

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