Murat DEMİRTAŞ, Önder TESKİN, Batuhan ÖZAY, Yavuz ENÇ, Azmi ÖZLER, Sabri DAĞSALI, Fikri YAPICI, Bülent KETENCİ

Bentall prosedürü ve modifikasyonlarının erken ve geç dönem sonuçları

Aort kapak yetersizliği ile birlikte olan asandan aort anevrizmalarının ve aort disseksiyonlarının tedavisinde ascending aortanın kompozit valve replasmanı ile tedavisi gittikçe artan oranlarda kullanılmaktadır. Günümüzde yaygın olarak kullanılan 4 teknik; Bentall, aortik buton,Carrel patch ve Cabrol teknikleridir. Bu dört teknik temelde benzer olmasına rağmen en önemli komplikasyon olan ve kanamaya yol açan koroner arter bağlantılarının nasıl olacağı konusunda birbirinden farklılaşır. Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahi Merkezi'nde ilk olarak; 1966 yıllında aort yetersizliği ile birlikte asandan aort anevrizmalı bir hastaya, 11 no. Starr Edwards kapak replasmanı ve anevrizma rezeksiyonu ile Dacron tüp greft kullanımı uygulanmıştır. 1984 yılından itibaren de Hastane'mizde, Bentall prosedürleri ve modifikasyonları uygulanmaktadır. Bu çalışma Merkezi'mizde Ocak 1984 ve Ocak 2000 yılları arasında 47 hastaya uygulanan Bentall prosedürü ve modifikasyonlarının erken ve geç dönem sonuçlarının retrospektif olarak değerlendirilmesi amacıyla yapılmıştır. Sadece 2 hasta Cabrol prosedürü ile opere edildi ve çalışma dışı bırakıldı. Bentall yapılan total 18 hastanın 6'sında erken 3'ünde geç ölüm görülmüştür. Buton tekniği ile opere edilen 16 hastadan 1'inde erken ölüm görülmüştür. Carrel patch prosedürü uygulanan 11 hastada ise ölüm görülmemiştir. Sonuç olarak; Kliniği'mizde buton ve Carrel patch prosedürleri mortalite açısından Bentall tekniği ile karşılaştırıldığında belirgin olarak daha başarılı sonuçlar vermiştir.

Early and late results of bentall procedure and it's modifications

Composite valve replacement of the ascending aorta is being increasingly used for the treatment of aortic aneurysms with aortic valve insuffiency and aortic dissection. Today, the most commonly used four technıques are the Bentall's, button,Carrel patch and Cabrol's techniques. These four techniques are different from each other on the basis of coronary artery ostial reattachment that is the reason of most common complication, bleeding. In 1966, one patient with aortic insufficiency and ascending aorta aneurysm was treated with the replacement of the aortic valve with no:11 Star Edwards valve and ascending aorta with Dacron tube graft after resection at Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center for the first time. After 1984, Bentall procedure and its modifications were being commonly used for the treatment of ascending aorta aneurysms with valve insuffiency and aortic dissection ın our hospital. This study was done to evaluate retrospectively the early and late results of Bentall and its modifications performed in 47 patients between April 1984 and January 2000 in our center. Only two patients are operated by 1 Cabrol procedure and excluded from this study. Totaly 18 patients were operated by Bentall procedure. Six of these patients died within early postoperative period and three patients died later on. Only one of 16 patients who were operated by button technique had early postoperative death. No early and late death were seen in 11 patients that had been operated on with button and carrel patch. As a conclusion, the mortality rate of button and carrel patch is signifıcantly much better than Bentall procedures ın our center.

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