Orhan Kemal SALİH, Mehmet Şah TOPCUOĞLU, Atakan ATALAY, Yüksel BAŞTÜRK, Vecih KEKLİK, Hafize YALNIZ, Uğur GÖÇEB, Yasin GÜZEL, Nazım ÖZBARLAS, Mehmet ASLAN, Sevcan ERDEM

İntrakardiyak defektlerin onarımında sığır perikard ve Dakron yamanın kısa ve orta dönem sonuçlarının karşılaştırılması

Amaç: Bu çalışmada intrakardiyak defektlerin kapatılmasında farklı dönemlerde kullanılan sığır perikard ve Dakron yama materyalinin kısa ve orta dönem sonuçları klinik ve transtorasik ekokardiyografik olarak karşılaştırıldı. Çalışma planı: Mart 1992 - Aralık 2003 tarihleri arasında kliniğimizde intrakardiyak defekt onarımında Dakron yama (grup 1) kullanılan 498 hasta ile Ocak 2004 - Nisan 2010 tarihleri arasında sığır perikard yaması (grup 2) kullanılan 533 hastaya ilişkin kısa (ameliyat sonrası 30 gün) ve orta (ameliyat sonrası 24 ay) dönem sonuçlar karşılaştırıldı. Bulg ul ar: Her iki grupta kısa ve orta dönemde yapılan ekokardiyografik çalışmalarda yamada kalsifikasyon, trombüs, anevrizmatik dilatasyon görülmedi. Grup 1de üç hastada, grup 2de iki hastada yamada vejetasyon-endokardit tespit edildi. Grup 1de 15 ve grup 2de 14 hastada rezidüel ventriküler septal defekt görüldü. Bu komplikasyonların görülme oranı, gruplar arasında istatistiksel olarak anlamlı bulunmadı. Sonuç: Çalışma bulgularımız, klinik olarak sığır perikard yamasının elastikiyeti, ve kolay kullanım özelliği nedeniyle, basit ve kompleks intrakardiyak defektlerin onarılmasında, Dakron yamaya kıyasla, daha uygun olduğunu göstermektedir.

Acomparison between the bovine pericardial and Dacron patchinrepair of intracardiac defects: the short and mid-term results

Background: In this study, we compared the short- and mid-term clinical and transthoracic echocardiographic results of bovine pericardial and Dacron patch materials used in repair of intracardiac defects. Methods: We compared the short (30 days postoperatively) and mid-term (up to 24 months postoperatively) results of 498 patients with intracardiac defect who underwent surgical correction using Dacron patch (group 1) between March 1993 and December 2003 with 533 patients who received a bovine pericardial patch (group 2) between January 2004 and April 2010. Results: The short- and mid-term postoperative echocardiographic studies showed no evidence of calcification, thrombus, aneurysmal dilatation around the patch in either group. Vegetation-endocarditis developed in three patients in group 1 and two patients in group 2. Residual ventricular septal defect developed in 15 patients in group 1 and in 14 patients in group 2. The incidence of these complications was not statistically significant between the groups. Conclusion: Our study results suggest that bovine pericardial patch is more appropriate in repair of simple and complex intracardiac defects thanks to its elasticity and easy-to-use nature, compared to Dacron patch.

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1. Mohri H, Barnes RW, Rittenhouse EA, Reichenbach DD, Dillard DH, Merendino KA. Fate of autologous pericardium and dacron fabric used as substitutes for total atrial septum in growing animals. J Thorac Cardiovasc Surg 1970;59:501-11.
2. McGoon DC. Long-term effects of prosthetic materials. Am J Cardiol 1982;50:621-30.
3. Ionescu MI, Tandon AP, Mary DA, Abid A. Heart valve replacement with the Ionescu-Shiley pericardial xenograft. J Thorac Cardiovasc Surg 1977;73:31-42.
4. Kirklin JW, Barratt-Boyes BG, editors. Cardiac surgery. Edinburg: Churchill Livingstone; 1993.
5. Alehan D, Doğan R, Ozkutlu S, Elshershari H, Gümrük F. Severe hemolytic anemia after repair of primum septal defect and cleft mitral valve. Turk J Pediatr 2001;43:329-31.
6. Di Eusanio M, Schepens MA. Left atrial thrombus on a Teflon patch for ASD closure. Eur J Cardiothorac Surg 2002;21:542.
7. Hayabuchi Y, Mori K, Kitagawa T, Sakata M, Kagami S. Polytetrafluoroethylene graft calcification in patients with surgically repaired congenital heart disease: evaluation using multidetector-row computed tomography. Am Heart J 2007;153:806.e1-8.
8. Us MH, Sungun M, Sanioglu S, Pocan S, Cebeci BS, Ogus T, et al. A retrospective comparison of bovine pericardium and polytetrafluoroethylene patch for closure of ventricular septal defects. J Int Med Res 2004;32:218-21.
9. Ishihara T, Ferrans VJ, Jones M, Boyce SW, Roberts WC. Structure of bovine parietal pericardium and of unimplanted Ionescu-Shiley pericardial valvular bioprostheses. J Thorac Cardiovasc Surg 1981;81:747-57.
10. Ionescu MI, Tandon AP, Macartney FJ. Long-term sequential hemodynamic evaluation of right ventricular outflow tract reconstruction using a valve mechanism. Ann Thorac Surg 1979;27:426-34.
11. Lukács L L, Záborszky B B, Sárközy K K, Arvay A. Reconstruction of the right ventricular outflow tract with bovine pericardial monocusp patch. Tex Heart Inst J 1984;11:234-7.
12. Crawford FA Jr, Sade RM, Spinale F. Bovine pericardium for correction of congenital heart defects. Ann Thorac Surg 1986;41:602-5.
13. Castaneda AR, Jonas RA, Mayer Jr JE, Hanler FL. Congenital heart defect and procedures. Castaneda AR, Jonas RA, Mayer Jr JE, Hanley FL. Cardiac surgery of the neonate and infant. Philadelphia: W.B. Saunders Company; 1994. p. 187-201.
14. Hardin JT, Muskett AD, Canter CE, Martin TC, Spray TL. Primary surgical closure of large ventricular septal defects in small infants. Ann Thorac Surg 1992;53:397-401.
15. Li X, Guo Y, Ziegler KR, Model LS, Eghbalieh SD, Brenes RA, et al. Current usage and future directions for the bovine pericardial patch. Ann Vasc Surg 2011;25:561-8. doi: 10.1016/j.avsg.2010.11.007.
16. Obermiller JF, Hodde JP, McAlexander CS, Kokini K, Badylak SF. A comparison of suture retention strengths for three biomaterials. Med Sci Monit 2004;10:PI1-5.
17. Cunanan CM, Cabiling CM, Dinh TT, Shen SH, Tran- Hata P, Rutledge JH 3rd, et al. Tissue characterization and calcification potential of commercial bioprosthetic heart valves. Ann Thorac Surg 2001;71:S417-21.
18. Neethling WM, Hodge AJ, Clode P, Glancy R. A multi- step approach in anti-calcification of glutaraldehyde- preserved bovine pericardium. J Cardiovasc Surg (Torino) 2006;47:711-8.
19. Gabbay S, Bortolotti U, Factor S, Shore DF, Frater RW. Calcification of implanted xenograft pericardium. Influence of site and function. J Thorac Cardiovasc Surg 1984;87:782-7.