Triküspid kapak replasmanı geçiren hastalarda metalik ve biyoprotez kapakların sonuçlarının değerlendirilmesi.

Özet: Giriş: Valvüler kalp hastalığı tedavisi için çok çeşitli prosedürler mevcuttur. Cerrahi tedavisinde mekanik kapaklar ve biyoprotez (doku) kapaklar arasında hangi kapak türünün diğerinden üstün olduğuna ilişkin henüz bir görüş birliği tam olarak mevcut değildir. Bu çalışmanın amacı çeşitli nedenlerle metalik kapak ve biyoprotezler ile trisküspid kapak replasman cerrahisi uygulanan hastaların klinik sonuçları ve komplikasyonları açısından değerlendirilmesidir. Gereç ve Yöntem: Çalışmamıza 2016 ile 2018 tarihleri arasında Pamukkale Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı’nda triküspid kapak replasmanı geçiren ve yaşları 40 ile 79 yıl arasında değişen 14 hasta dahil edilmiştir. Çalışmaya katılan hastaların yaş ve cinsiyet gibi demografik verileri, yapılan operasyon türü, yerleştirilen kapak tipi, ejeksiyon fraksiyonu, atriyum çapı, postopretatif komplikasyon, diyaliz gerekliliği, redo operasyon ve kriyo ablasyon gereksinimi ve sağ kalım durumları kaydedilmiştir. Bulgular: Hastaların 10’unda (%71.4) biyoprotez ve 4’ünde (%28.6) mekanik protez kapak kullanılmıştır. Mekanik kapak takılan hastalarla biyoprotez kapak takılan hastalar arasında komplikasyonlar açısından anlamlı fark saptanmamıştır (p>0.05). Her iki grup arasında sağ kalım açısından istatistiksel olarak anlamlı fark yoktu (p=0.594). Hayatını kaybeden hastalarda ortalama yaş istatistiksel olarak farklı bulundu(p=0.043). Ortalama yaş eksitus olan hastalarda 60.5 (min-maks: 50-77) yıl ve sağ kalanlarda 48 (min-maks: 40-79) yıldır. Sonuç: Bulgularımız triküspid pozisyonda yerleştirilen protezin türünün postoperatif komplikasyonları ve sağ kalımı üzerine bir etkisi olmadığını göstermektedir. Ancak daha geniş seriler ile prospektif uzun süreli takipler yapılması detaylı karşılaştırmalar için gerekmektedir.

Anahtar Kelimeler:

biyolojik protez, sağ kalım, Triküspid kapak replasmanı, mekanik protez, komplikasyon

Evaluation of the results of metallic and bioprosthesic valves in patients with tricuspid valve replacement.

A wide variety of procedures are available for the treatment of valvular heart disease. There is no consensus on the type of valve that is superior to the other between mechanical valves and bioprosthesis (tissue) valves in surgical treatment. The aim of this study was to evaluate the clinical outcomes and complications of patients undergoing tricuspid valve replacement surgery with metallic valve and bioprosthesis for various reasons.Material and Method: Fourteen patients, aged between 40 and 79 years, who underwent tricuspid valve replacement in the Department of Cardiovascular Surgery, Pamukkale University Faculty of Medicine between 2016 and 2018 were included in the study. Demographic data such as age and sex, type of operation, valve type, ejection fraction, atrial diameter, postopretative complications, dialysis requirement, redo operation and cryo ablation requirement and survival status of the patients were recorded.Results: Bioprosthesis was used in 10 (71.4%) and mechanical prosthetic valve was used in 4 (28.6%) of the patients. There was no significant difference between the patients with mechanical valve and bioprosthesis valve in terms of complications (p>0.05). There was no statistically significant difference between the two groups in terms of survival (p=0.594). The mean age of the patients who died was statistically different (p=0.043). The mean age was 60.5 (min-max: 50-77) years in patients who died and 48 (min-max: 40-79) years in survivors. Conclusion: Our results show that the type of prosthesis placed in the tricuspid position has no effect on postoperative complications and survival. However, larger series and prospective long-term follow-up are necessary for detailed comparisons.

Keywords:

biological prosthesis, Tricuspid valve replacement, mechanical prosthesis, complication, survival,

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1. Nkomo VT, Gardin JM, Skelton TN et al. Burden of valvular heart diseases: a population–based study. Lancet 2006; 368(9540): 1005–1011.2. Coffey S, Cairns BJ, Iung B. The modern epidemiology of heart valve disease. Heart. 2016 Jan;102(1):75-85.3. Pibarot P, Dumesnil JG. Prosthetic heart valves: Selection of the optimal prosthesis and longterm management. Circulation 2009;119(7):10341048. 4. Calafiore AM1, Iacò AL, Romeo A, Scandura S, Meduri R et all. Echocardiographic-based treatment of functional tricuspid regurgitation. J Thorac Cardiovasc Surg. 2011 Aug;142(2):308-13. 5. Iscan ZH, Vural KM, Bahar I, Mavioglu L, Saritas A. What to expect after tricuspid valve replacement? Long-term results. Eur J Cardiothorac Surg. 2007 Aug;32(2):296-300. Epub 2007 Jun 6.6. Ratnatunga CP, Edwards MB, Dore CJ, Taylor KM.Tricuspid valve replacement: UK heart valve registry mid-term results comparing mechanical and bioprosthesis prosthesis. Ann Thorac Surg 1998;66:1940–7.7. Van Nooten GJ1, Caes F, Taeymans Y, Van Belleghem Y, François K et al. Tricuspid valve replacement: postoperative and long-term results. J Thorac Cardiovasc Surg. 1995 Sep;110(3):672-9.8. McGrath LB, Lavin LG, Bailey BM, Grunkemeier GL, Fernandez J, Laub GW. Tricuspid valve operations in 530 patients. J Thorac Cardiovasc Surg 1990;99:124–33.9. Kawachi Y, Tominaga R, Hisahara M, Nakashima A, Yasni H, Tokuna K. Excellent durability of the Hancock porcine bioprosthesis in the tricuspid position. J Thorac Cardiovasc Surg 1992;104:1561–6.10. Kaplan M, Kut MS, Demirtas MM, Cimen S, Ozler A. Prosthetic replacement of tricuspid valve: bioprosthetic or mechanical. Ann Thorac Surg. 2002 Feb;73(2):467-73. 11. Mangoni AA, DiSalvo TG, Vlahakes GJ, Polanczyk CA, Fifer MA. Outcome following isolated tricuspid valve replacement. Eur J Cardiothorac Surg. 2001;19(1):68-73.12. Rizzoli G, Perini LD, Bottio T, Minutolo G, Thiene G, Casarotto D. Prosthetic replacement of the tricuspid valve: biological or mechanical? Ann Thorac Surg 1998;66:62–7.13. Carrier M, Hebert Y, Pellerin M, Bouchard D, Perrault LP, Cartier R, et al. Tricuspid valve replacement: an analysis of 25 years of experience at a single center. Ann Thorac Surg. 2003;75(1):47-50.14. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP et al. Society of Cardiovascular Anesthesiologists. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol. 2007 Mar 6;49(9):1014.15. Garatti A, Nano G, Bruschi G, Canziani A, Colombo T et al. Twenty-five year outcomes of tricuspid valve replacement comparing mechanical and biologic prostheses. Ann Thorac Surg. 2012 Apr;93(4):1146-53.16. Kawano H, Oda T, Fukunaga S, Tayama E, Kawara T, Oryoji A, et al. Tricuspid valve replacement with the St. Jude Medical valve: 19 years of experience. Eur J Cardiothorac Surg. 2000;18(5):565-9.17. Akinosoglou K, Apostolakis E, Koutsogiannis N, Leivaditis V, Gogos CA. Right-sided infective endocarditis: surgical management. Eur J Cardiothorac Surg. 2012;42(3):470-9.