Sait AŞLAMACI, Salih ÖZÇOBANOĞLU, Süleyman ÖZKAN, Murat ÖZKAN, Bülent SARITAŞ

Doğuştan kalp hastalıklarında ksenogreft kapaklı kondüit kullanımı

Amaç: Pulmonik ventrikül ile pulmoner arter arasındaki devamlılığı sağlamak amacı ile kullandığımız ksenogreftlerdeki dokuz yıllık deneyimlerimiz ve tekrar ameliyatlarına ilişkin risk faktörlerinin belirlenmesi amaçlandı. Çalışma planı: Ocak 2000 - Ocak 2009 tarihleri arasında ksenogreft kondüitler ile açık kalp ameliyatı yapılan 176 hasta retrospektif olarak değerlendirildi. Toplamda 215 kondüit kullanıldı (ilk ameliyatlarda ve tekrar ameliyatlarında). Yetmiş dört hastada Shellhigh, 53 hastada Contegra, 42 hastada Cryolife, 35 hastada Aortech, sekiz hastada Tissumed ve üç hastada diğer kondüit türleri kullanıldı. Hastalar taburcu edildikten sonra altı aylık düzenli aralıklarla transtorasik ekokardiyografi ile değerlendirildi. Kontrole gelen tüm hastaların 12-derivasyonlu elektrokardiyografileri çekildi. Transtorasik ekokardiyografi ile önemli kondüit darlığı ya da yetmezliği saptanan hastalarda kardiyak kateterizasyon yapıldı. Bulgular: Erken hastane mortalitesi %17 (n=30) idi. Bu hastalar, düşük kardiyak debi (n=9), kanama (n=4), aritmi (n=7), serebrovasküler olay (n=3), infeksiyon (n=4) ve diğer nedenlerle (n=3) kaybedildi. Bu hastalar truncus arteriozus (n=19), büyük arterlerin transpozisyonu (n=5), Fallot tetralojisi (n=2), pulmoner atrezi (n=2) ve çift çıkımlı sağ ventrikül (n=2) nedeni ile ameliyat edildi. Ortalama takip süresi 78±21 ay idi. Otuz dokuz hasta (%22.1) kondüit yetmezliğinden tekrar ameliyat edildi. İlk ameliyat ile tekrar ameliyatı arasında geçen ortalama süre 43±28 ay idi. Bu süre Cryolife ve Tissumed de en uzun, Contegra ve Shellhigh da en kısaydı. Tekrar ameliyatları en sık büyük arterlerin transpozisyonu- ventriküler septal defekt ve pulmoner atrezili hasta grubunda yapıldı. Sonuç: Ksenogreft transplantasyon, doğuştan kalp cerrahisinde önemli bir yer tutmaktadır fakat tekrar ameliyat gerekliliği en önemli dezavantajıdır. İstatistiksel bir fark saptanmamış olsa da erken ameliyat yaşı ve porcine konduit kullanılması tekrar ameliyat için önemli risk faktörleridir.

Use of xenograft conduits in congenital heart disease

Background: We aimed to evaluate our nine years of experience with xenograft conduits in which we constructed continuity between the pulmonic ventricle and pulmonary artery and to determine the risk factors for reoperations. Methods: One hundred and seventy-six patients who underwent open heart surgery with xenograft conduits between January 2000 and January 2009 were evaluated retrospectively. Overall, 215 conduits were used (in the first operations and reoperations). Shellhigh conduits were used in 74 patients, Contegra in 53, Cryolife in 42, Aortech in 35, Tissumed in eight, and other types of conduits were used in three patients. After discharge, all patients were evaluated by transthoracic echocardiography at regular six-month intervals. Twelvederivation electrocardiograms were obtained from all patients during the control visits. Cardiac catheterization was performed when transthoracic echocardiography demonstrated significant conduit stenosis or regurgitation. Results: Early hospital mortality was 17% (n=30). These patients died due to low cardiac output (n=9), bleeding (n=4), arrhythmia (n=7), cerebrovascular accident (n=3), infection (n=4), and other reasons (n=3). These patients were operated on due to truncus arteriosus (n=19), transposition of great arteries (n=5), tetralogy of Fallot (n=2), pulmonary atresia (n=2), and double outlet right ventricle (n=2). The mean followup time was 78±21 months. Thirty-nine (22.1%) patients were reoperated on due to conduit failure. The interval between the first operation and reoperation was 43±28 months. This interval was the shortest with the Cryolife and Tissumed conduits and longest with the Contegra and Shellhigh ones. Reoperation was performed frequently in patients with transposition of great arteries, ventricular septal defect, and pulmonary atresia. Conclusion: Xenograft transplantation is important in congenital heart disease, but the reoperation requirement is the most important disadvantage. Although there is no statistical significance, early operation age and use of porcine conduit are the risk factors for reoperation.

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