Haşim USTUNSOY, Mehmet KERVANCIOĞLU, Gökhan GÖKASLAN, Özerdem ÖZÇALIŞKAN, Hayati DENİZ, Alptekin YASİN, Cem ATİK, Eren Oral KALBİSAĞDE

Early- and mid-term results of off-pump pulmonary valve implantation: a single-center experience

Amaç: Bu çalışmada atan kalpte pulmoner kapak implantasyonunun (PKİ) erken ve orta dönem sonuçları değerlendirildi. Çalışma planı: Ekim 2006 - Şubat 2012 tarihleri arasında dokuz hastaya (5 erkek, 4 kadın; ort. yaş 18.4±6.3 yıl; dağılım 8-27 yıl) enjekte edilebilen stent ile PKİ yapıldı. Tüm hastalarda ekokardiyografik olarak şiddetli pulmoner kapak yetmezliği, ilerlemiş sağ ventrikül dilatasyonu ve disfonksiyonu vardı. Hiçbir hastada rezidüel ventriküler septal defekt (VSD) görülmedi. Bulgular: Çalışmada bir hastaya 23 mm, iki hastaya 25 mm, iki hastaya 27 mm, üç hastaya 29 mm ve bir hastaya 31 mm kapak implante edildi. Ameliyat sonrası ekokardiyografik incelemede yedi hastada hiç kapak yetmezliğine rastlanmazken, iki hastada hafif derecede kapak yetmezliği saptandı. Ortalama pik sistolik gradyanı 12.6±3.7 mmHg ve ortalama sistolik gradyanı 8.3±2.4 mmHg olarak hesaplandı. Ortalama takip süresi 34±17 ay (dağılım, 1.5 ila 58 ay) idi. Hastaların hiçbirine tekrar ameliyat gerekmedi. Sonuç: Atan kalpte PKİnin avantajları; kardiyopulmoner baypas olmaksızın uygulanabilmesi, büyük boyutlu kapakların kullanılabilirliği, herhangi bir girişim sınırlamasının olmaması ve kapağın yer değiştirmesini önleyecek şekilde kapağın pulmoner artere tespitine imkan vermesidir. Kapağın no-react özelliği, kapak dejenerasyon riskini de azaltmaktadır.

Atankalptepulmonerkapakimplantasyonunun erkenve orta dönem sonuçları:Tek merkez deneyimi

Background: This study aims to assess the early- and midterm results of off-pump pulmonary valve implantation (PVI). Methods: Between October 2006 and February 2012, nine patients (5 males, 4 females; mean age 18.4±6.3 years; range 8 to 27 years) underwent off-pump PVI with an injectable stent. Echocardiography revealed severe pulmonary valve regurgitation, progressive right ventricular dilatation and dysfunction in all patients. No residual ventricular septal defect (VSD) was seen. Results: We implanted a 23 mm valve in one patient, a 25 mm valve in two patients, a 27 mm valve in two patients, a 29 mm valve in three patients and a 31 mm valve in one patient. Postoperative echocardiographic examination revealed no regurgitation in seven patients with mild valve regurgitation in two patients. The mean peak systolic gradient was 12.6±3.7 mmHg, while the mean systolic gradient was 8.3±2.4 mmHg. The mean follow-up was 34±17 months (range, 1.5 to 58 months). None of the patients needed reoperation. Conclusion: The advantages of off-pump PVI include the applicability without cardiopulmonary bypass, availability of large-sized valves, the absence of any interventional limitation and the opportunity for fixation into the pulmonary artery to avoid valve migration. No-react nature of the valve also minimizes the degeneration risk of the valve.

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