Nevzat ERDİL, Ufuk DEMİRKILIÇ, Harun TATAR, Erol ŞENER, Levent ÇETİN, Şanser ATEŞ

Dar aort annuluslu hastalarda yeni jenerasyon mekanik kapak: St. Jude regent aortik protez deneyimi

Amaç: St. Jude Regent kalp kapak protezi daha iyi hemodinamik performans, daha az gradiyent ve artırılmış kapak alanına sahiptir. Bu çalışmada aortik pozisyonda St. Jude Regent kalp kapak protezi kullandığımız ilk 12 hastanın erken hemodinamik ve klinik sonuçlarını vermekteyiz. Materyal ve Metod: Eylül 2000 - Aralık 2000 tarihleri arasında kliniğimizde 12 hastada aortik pozisyonda St. Jude Regent protez kapak implante edildi. Ortalama yaş 55.2±12.4 olup hastaların 7'si erkekti. Yedi hastada izole aort kapak replasmanı (AVR), 4 hastada AVR + mitral kapak replasmam, 1 hastada AVR + koroner bypass ameliyatı gerçekleştirildi. Hastalar klinik durum ve ekokardiyografik olarak ortalama 5±2 aylık takip sonrası değerlendirildi. Bulgular: Olguların 8'sinde 21 mm, 4'ünde 19 mm ölçüsünde kapak takıldı. Tüm olgularda aort annulusu dardı ve kapakta darlık ön plandaydı. Perioperatif mortalite gözlenmedi. Ortalama kros klemp zamanı 49.1 ± 22.7 dak, ortalama kardiyopulmoner bypass zamanı 62.2 ± 23.8 dak, ortalama yoğun bakım kalış süresi 1 gün, ortalama postoperatif hastane kalış süresi 6.7 ± 0.7 gün idi. Hastaların hiçbirinde erken postoperatif ve takip döneminde komplikasyon saptanmadı. Postoperatif ekokardiyografik değerlendirmede efektif kapak alanı 19 mm kapak için 1.5 ± 0.4 cm2, 21 mm kapak için 1.9 ± 0.6 cm2, ortalama maksimum gradient 19 mm için 27 ± 8 mmHg, 21 mm için 18 ± 4 mmHg olarak tespit edildi. Takip periyodunda tüm hastaların fonksiyonel kapasiteleri klas I'de idi. Sonuç: St. Jude Regent mekanik kapak protezi düşük transvalvular gradiyent ve artırılmış kapak alanına sahip olması bakımından dar aort annuluslu hastalarda daha iyi hemodinamik fonksiyon sağlamaktadır.

Experience of new generation mechanical valve in patients with small aortic annulus: St. Jude regent aortic prosthesis

Background: St. Jude Regent heart valve prosthesis has better hemodynamic performance, lesser gradient and increased effective orifice area. In this study, we present the early hemodynamic and clinical results of first 12 patients received St. Jude Regent heart valve prosthesis in aortic position. Methods: Between September 2000 - December 2000, St. Jude Regent heart valve prosthesis was replaced in aortic position in 12 patients. Mean age was 55.2 ± 12.4 years, and 7 of the patients were male. The procedures were isolated aortic valve replacement (AVR) in 7, AVR + mitral valve replacement in 4, and AVR + coronary artery bypass grafting in 1 patient. Patients were evaluated with echocardiography and also for clinical status in 5 $pm$ 2 months of follow-up. Results: The valve size was 21 mm in 8, and 19 mm in 4 of the cases. In all patients the aortic annulus was small and valvular stenosis was the primary problem. There was no perioperative mortality. Mean cross clamp time was 49.1 ± 22.7 minutes, mean cardiopulmonary bypass time was 62.2 ±23.8 minutes, mean stay time in intensive care unit was 1 day, and mean hospital stay time was 6.7 ± 0.7 days. No complication was detected in the early postoperative period and during follow-up. In postoperative echocardiographic evaluation, effective orifice area was measured as 1.5 ±0.4 cm2 for 19 mm valve, and 1.9 ± 0.6 cm2 for 21 mm valve, also mean maximum gradient was measured as 27 ± 8 mmHg for 19 mm valve, and 18 ± 4 mmHg for 21 mm valve. All of the patients were in class I functional capacity during follow-up period. Conclusions: St. Jude Regent mechanical heart valve prosthesis provides better hemodynamic function due to lesser transvalvular gradient and increased effective orifice area in patients with small aortic annulus.

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1.Sommers KE, David TE. Aortic valve replacement with patch enlargement of the aortic annulus. Ann Thorac Surg1997;63:1608-12.
2.Yamak B, İşlcan HZ, Ulus T, ve ark. Dar aortik annulusu olan ve 21-23 no St. Jude medikal protez ile aort kapak replasman› yap›lan hastaların uzun dönem sonuçları. Türk Kardiol Derg 1998;1:165-9.
3.Kadir I, Izzat MB, Wilde P, Reeves B, Bryan AJ, Angelini GD. Hemodynamics of St. Jude medical prosthesis in the small aortic root. J Heart Valve Dis 1997;6:123-9.
4.He GW, Grunkemeier GL, Gately HL, Furnary AP, Starr A. Up to thirty-year survival after aortic valve replacement in the small aortic root. Ann Thorac Surg 1995;59:1056-62.
5.Noera G, Pensa P, Lamarra M, Mascagni R, Cremonesi A, Balestra G. Hemodynamic evaluation of the Carbomedics, St. Jude Medical HPand Sorin-Bicarbon valve in patients with small aortic annulus. Eur J Cardiothorac Surg 1997;11:473-6.
6.Sawant D, Singh AK, Feng FC, Bert AA, Rotenberg F.Nineteen-millimeter aortic St. Jude Medical heart valve prosthesis: Up to sixteen years' follow-up. Ann Thorac Surg 1997;63:964-70.
7.Baudet E, Puel V, McPride J, Grimaud J, Roques F,Clerk E. Long term results of valve replacement with the St. Jude Medical prosthesis. J Thorac Cardiovasc Surg1995;109:858-70.
8.Arom K, Emery R, Petersen B, Radosevich D. St. Jude Medical valve prosthesis: Health status of the patient after 15 years. Ann Thorac Surg 1996;2:43-9.
9.Ellis JT, Yonathangan AP. Acomparison of the hinge and near hinge flow fields of the St. Jude Medical hemodynamic plus and regent bi-leaflet mechanical heart valves. J Thorac Cardiovasc Surg 2000;119:83-93.
10.Walker F, Brendzel A, Scotten L. The new St. Jude Medical Regent mechanical heart valve: Laboratory measurements of hydrodynamic performance. J Heart Valve Dis 1999;8:687-96.
11.Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision in to the anterior mitral leaflet. J Thorac Cardiovasc Surg 1979;78:402-12.
12.Blank RH, Pupello DF, Bessone LN, Harrison EE, Sbar S. Method of managing the small aortic annulus during valve replacement. Ann Thorac Surg 1976;22:356-61.
13.Konno S, Imai Y, Iida Y, Nakajima M, Tatsuno K. Anew method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring. J Thorac Cardiovasc Surg 1975;70:909-17.
14.David TE, Uden DE. Aortic valve replacement in adult patients with small aortic anuli. Ann Thorac Surg 1983;36:577-83.
15.Knott-Craig CJ, Elkins RC, Stelzer PL, et al. Homograft replacement of the aortic valve and root as a functional unit. Ann Thorac Surg 1994;57:1501-6.
16.Ross DN. Replacement of the aortic valve with a pulmonary autograft: The "switch" operation. Ann Thorac Surg 1991;52:1346-50.
17.Dell Rizzo DF, Goldman BS, David TE. Aortic valve replacement with a stentless porcine bioprosthesis: Multicentre trial. Canadian Investigators of the Toronto SPVvalve trial. Can J Cardiol 1995;11:597-603.
18.Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation 1978;58:20-4.
19.Dumesnil JG, Honos GN, Lemieux M, Beauchemin J. Vali-dation and application of indexed aortic prosthetic valve areas calculated by doppler echocardiography. J Am Coll Cardiol 1990;16:637-43.
20.Izzet MB, Kadir I, Reeves B, Vilde P, Bryan AJ, Angelini GD. Patient-prosthesis mismatch is negligible with modern small-size aortic valve prosthesis. Ann Thorac Surg 1999;68:1657-60.