İbrahim Kara, Alper ERKİN, Yasin Ay, Salih Salihi, Cengiz Köksal, Kaan Kırali

Mitral kapak prolapsusunda PTFE sütür ile yapay korda orta dönem sonuçları

Amaç: Korda rüptürü ya da elongasyonundan kaynaklanan Carpentier fonksiyonel sınıf II mitral kapak prolapsusu nedeni ile politetrafloroetilen (PTFE) sütür ile neokorda ve ring anüloplastiyle mitral onarım uygulanan hastaların orta dönem sonuçları araştırıldı.Yöntemler: 2009-2012 yılları arasında mitral leaflet prolapsusuna bağlı mitral yetmezliği (MY) tanısıyla onarım uygulanan 33 hasta değerlendirildi. Çalışma çapraz kesitli iki aşamalı olarak uygulandı. Çalışmaya dahil edilen hastaların hepsinde, aşırı leaflet hareketinin (korda rüptürü, korda elengasyonu) sebeb olduğu Carpentier tip II MY vardı. Hastaların orta dönem rekürrent mitral yetmezliğinden kurtulma, sağkalım ve yeniden cerrahi müdahale gereksinim oranları değerlendirildi.Bulgular: Hastane mortalitesi görülmedi. Orta dönem takipte (15.3±8.1 ay) sağ kalım %97 (32/33 hasta) idi. Takipte hastaların 6 (%18.8)'sında önemsiz (+1) MY, 2 (%6.1)'sinde hafif (+2) MY, 2 (%6.1)'sinde orta (+3) MY görülürken, şiddetli (+4) MY gelişen hastamız olmadı. Rekürrent ≥+2 MY'den kurtulma oranı %87.9 (29/33 hasta) idi. Hastalarımızdan 1'ine mitral tamir yetersizliği ve 1'sine 2. ayda orta (+3) MY gelişmesi sebebi ile reoperasyon uygulandı. Reoperasyon uygulanma oranı %6.1 (2/33 hasta) idi.Sonuç: Korda rüptür ya da elengasyon patolojisinden kaynaklanan kapak prolapsusunda PTFE sütür ile neokorda oluşturularak mitral onarım tatmin edici orta dönem sonuçları ile alternatif bir seçenek olarak tercih edilebilir.

Anahtar Kelimeler:

politetrafloroetilen, mitral kapak anülüs onarımı, sağ kalım, reoperasyon

Medium-term results of PTFE suture artificial chordae in mitral valve prolapse

Objective: Mid-term results of mitral valve repair with polytetrafluoroethylene (PTFE) suture neochordae and ring annuloplasty on patients with Carpentier functional class II mitral valve prolapse caused by rupture or elongation of chordae were investigated.Methods: 33 patients underwent repair of mitral regurgitation (MR) due to mitral leaflet prolapse between 2009 and 2012, were evaluated. Cross-sectional study was performed in two stages. All of the patients included in the study had Carpentier type II MY caused by excessive leaflet motion (elongation or rupture of chordae). At medium term follow-up, the ratio of riddance from recurrent mitral insufficiency, survival and reoperation were evaluated.Results: There was no hospital mortality. Medium-term (15.3 ± 8.1 months) survival was 97% (32/33 patients). At follow-up, while 6 (18.8%) patients had trivial (+1) MR, 2 (6.1%) patients had mild (+2) MR, 2 (6.1%) patients had moderate (+3) MR and no patients had severe (+4 ) MR. Freedom from ≥+2 recurrent MR was 87.9% (29/33 patients). The application rate of reoperation was 6.1% (2/33 patients). Two patients underwent reoperative mitral valve replacement because of the development of mitral repair failure in 1 patient and moderate (+3) MR in 1 patient within 2 month.Conclusion: Repair of mitral leaflet with PTFE suture neochordae in mitral valve prolapse due to pathologies of chordae rupture or elongation may be preferred as an alternative with satisfactory mid-term results.

Keywords:

polytetrafluoroethylene, mitral valve annulus repair, survival, reoperation,

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