Kahraman YAKUT, Birgül VARAN, Niyazi Kürşad TOKEL, İlkay ERDOĞAN, Murat ÖZKAN

Doğumsal aort kapak darlığında balon ve cerrahi valvuloplasti sonuçları: 19 yıllık, tek merkezli, retrospektif çalışma

Amaç: Bu çalışmada, doğumsal aort kapak darlığı olan çocuk hastalarda aort balon valvuloplasti ve cerrahi aort valvuloplastinin başarısı, komplikasyonları ve uzun dönem sonuçları karşılaştırıldı. Çalışma planı: Mart 2000 - Ekim 2019 tarihleri arasında 198 çocukta (135 erkek, 63 kadın; ort yaş: 57.4±62.6 yıl; dağılım, 0.03 to 219 yıl) 238’i balon valvuloplasti ve 29’u cerrahi valvuloplasti olmak üzere toplam 267 işlem retrospektif olarak incelendi. Hastane kayıtları, ekokardiyografi görüntüleri, kateterizasyon verileri, anjiyografi görüntüleri ve ameliyat verileri değerlendirildi. Bulgular: Balon valvuloplasti öncesi 73 hastada aort yetersizliği hafif düzeyde idi ve hastaların hiçbirinde orta ila şiddetli aort yetersizliği yoktu. Cerrahi valvuloplastiye kıyasla, balon valvuloplasti sonrası aort yetersizliğindeki artış oranı anlamlı düzeyde yüksekti (p=0.012). Balon valvuloplasti uygulanan hastalarda ortalama 46±45.6 ay süreyle tekrar girişim gerekmez iken, bu süre cerrahi valvuloplasti uygulanan hastalarda anlamlı düzeyde daha uzundu (ortalama: 80.5±53.9 ay) (p=0.018). Genel başarısızlık oranı %8 idi. Orta ila şiddetli aort yetersizliği, balon valvuloplastiye bağlı erken dönemde görülen en önemli komplikasyon idi (%13). Cerrahi valvuloplastilerin tümü başarılı idi. Balon valvuloplasti sonrasında ortalama hastanede kalış süresi, cerrahi valvuloplastiye kıyasla anlamlı düzeyde daha kısa idi (p=0.026). Takiplerine devam eden 168 hastanın 78’inde (%47), tekrar girişimsel veya cerrahi müdahaleye gerek duyulmadı. Sonuç: Aort balon valvuloplasti, güvenli bir şekilde tekrarlanabilir ve sternotomi ihtiyacı olmaksızın aort kapak darlığını ortadan kaldırabilir. Cerrahi valvuloplasti ise, aort balon valvuloplastiden beklenen yararın elde edilemediği hastalarda başarılı bir şekilde uygulanabilir.

Results of balloon and surgical valvuloplasty in congenital aortic valve stenosis: A 19-year, single-center, retrospective study

Background: This study aims to compare the success, complications, and long-term outcomes of aortic balloon valvuloplasty and surgical aortic valvuloplasty in pediatric patients with congenital aortic valve stenosis. Methods: Between March 2000 and October 2019, a total of 267 procedures, including 238 balloon valvuloplasties and 29 surgical valvuloplasties, in 198 children (135 males, 63 females; mean age: 57.4±62.6 months; range, 0.03 to 219 months) were retrospectively analyzed. The hospital records, echocardiographic images, catheterization data, angiography images, and operative data were reviewed. Results: Aortic regurgitation was mild in 73 patients before balloon valvuloplasty, and none of the patients had moderate-to-severe aortic regurgitation. Compared to surgical valvuloplasty, the rate of increase in the aortic regurgitation after balloon valvuloplasty was significantly higher (p=0.012). The patients who underwent balloon valvuloplasty did not need reintervention for a mean period of 46±45.6 months, whereas this period was significantly longer in those who underwent surgical valvuloplasty (mean 80.5±53.9 months) (p=0.018). The overall failure rate was 8%. Moderate-to-severe aortic regurgitation was the most important complication developing due to balloon valvuloplasty in the early period (13%). All surgical valvuloplasties were successful. The mean length of hospitalization after balloon valvuloplasty was significantly shorter than surgical valvuloplasty (p=0.026). During follow-up, a total of 168 patients continued their follow-up, and a reinterventional or surgical intervention was not needed in 78 patients (47%). Conclusion: Aortic balloon valvuloplasty can be repeated safely and helps to eliminate aortic valve stenosis without needing sternotomy. Surgical valvuloplasty can be successfully performed in patients in whom the expected benefit from aortic balloon valvuloplasty is not achieved.

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