Evren ÖZÇINAR, Mustafa Serkan DURDU, Mustafa Bahadır İNAN, Ahmet Rüçhan AKAR, Çağdaş BARAN, Sadık ERYILMAZ, Fatih GÜMÜŞ, Mehmet ÇAKICI

İmplante edilebilen kardiyak elektronik cihazlar ile ilişkili endokarditte triküspid kapak cerrahisi: Onarım mı replasman mı?

Amaç: Bu çalışmada, elektrot endokarditi ile ilişkili triküspid kapak yetmezliği araştırıldı, altta yatan nedenler belirlendi ve triküspid kapak endokarditine ilişkin cerrahi yaklaşımlarımız sunuldu. Çalışma planı: Mart 2010 - Ağustos 2016 tarihleri arasında, daha önce implante edilebilir elektronik cihaz olarak yerleştirilen elektrodun neden olduğu endokardit ile ilişkili şiddetli triküspid yetmezliği nedeniyle triküspid kapak cerrahisi yapılan toplam 43 hastanın (23 erkek, 20 kadın; ort. yaş 63.2±13.6 yıl; dağılım 48 -72 yıl) tıbbi kayıtları incelendi. Enfekte elektrotlar ve jeneratörler dahil olmak üzere tüm sistem çıkarıldı; enfekte yaralar ve dokulara revizyon uygulandı; elektrot endokarditi nedeniyle triküspid kapak cerrahisi yapıldı ve kültür ile doğrulandığı üzere etken ajana yönelik uzun dönem intravenöz antibiyotik tedavisi uygulandı. Bulgular: Elektrot endokarditi ile ilişkili şiddetli triküspid kapak yetmezliği nedeniyle 43 hastanın 18’ine triküspid kapak tamiri, 25’ine ise triküspid kapak replasmanı uygulandı. Takip boyunca (dağılım: 2-62 ay), iki hastada ameliyat sonrası akut sağ kalp yetmezliğine bağlı geçici mekanik destek ihtiyacı olurken, sekiz hasta sepsis (n=6; %14) ve inme (n=2; %4.6) nedeniyle ameliyat sonrası erken dönemde kaybedildi. Geri kalan hastaların kalp yetmezliği bulgu ve belirtilerinde anlamlı düzelme izlendi. Sonuç: Çalışma sonuçlarımız, yetersiz deneyim ve yanlış kapak onarımı kararının kapak replasmanını geciktirebileceğini ve ameliyat süresini uzatabileceğini göstermektedir.

Tricuspid valve surgery in implantable cardiac electronic device-related endocarditis: Repair or replace?

Background: The aim of this study was to investigate lead endocarditis-related tricuspid valve regurgitation, to identify underlying causes, and to report our surgical approaches to tricuspid valve endocarditis.Methods: Between March 2010 and August 2016, medical records of a total of 43 patients (23 males, 20 females; mean age: 63.2±13.6 years; range 48 to 72 years) who underwent tricuspid valve surgery for severe tricuspid regurgitation caused by lead endocarditis, which was previously placed as an implantable cardiac electronic device were reviewed. We removed all systems including infected leads and generators, revised infected wounds and tissues, performed tricuspid valve surgery for lead endocarditis, and applied long-term intravenous antibiotic regimen for the culprit agent, as confirmed by the culture.Results: Of 43 patients, 18 underwent tricuspid valve repair and 25 underwent tricuspid valve replacement for lead endocarditis-related severe tricuspid valve regurgitation. During follow-up (range, 2 to 62 months), two patients required temporary mechanical support due to postoperative acute right heart failure, while eight patients died due to sepsis (n=6; 14%) and stroke (n=2; 4.6%) in the early postoperative period. The remaining patients showed significant improvement in signs and symptoms of heart failure.Conclusion: Our study results suggest that incompetent experience and inaccurate decision for valve repair may result in delayed valve replacement and prolonged operation time.

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