Mitral kapak onarımın dayanıklığı: Tek merkez deneyimi

Amaç: Bu çalışmada farklı etiyolojileri olan hastalarda mitral kapak onarımının klinik sonuçları sunuldu. Çalışma planı: Haziran 2006 - Ağustos 2017 tarihleri arasında eş zamanlı kardiyak ameliyat ile birlikte veya tek başına mitral kapak onarımı yapılan toplam 421 ardışık hasta (266 erkek, 155 kadın; ort. yaş 53.1±15.6 yıl; dağılım, 5-89 yıl) retrospektif olarak incelendi. Tüm ameliyat öncesi, sırası ve sonrası veriler toplandı. Ekokardiyografik incelemeler taburculukta ve takip sırasında yapıldı. Kaplan-Meier analizi genel sağkalım ve rezidüel ciddi mitral yetmezlik, endokardit ve tekrar ameliyatsız sağkalım oranlarının tahmininde kullanıldı. Bulgular: Ortalama takip süresi 58.9±35.1 ay idi. Hastaların 12’si (%2.8) daha önce kalp ameliyatı geçirmişti. En yaygın patoloji 265 hastada (%62.9) dejeneratif hastalık idi. Onarım teknikleri ring anüloplasti (n=366, %86.9), yapay korda implantasyonu (n=185, %44) ve komissürotomi (n=38, %9) idi. Genel olarak hastane mortalitesi %1.2 (n=5) idi. Taburculuk öncesinde ekokardiyografide hastaların %64.9’unda (n=270) mitral yetmezlik izlenmedi veya önemsiz mitral yetmezlik izlendi ve hastaların %34.85’inde (n=145) hafif mitral yetmezlik izlendi. Ameliyat sonrası geç dönemde, transtorasik ekokardiyografide 23 hastada (%5.7) orta dereceli ve 11 hastada (%2.7) ciddi mitral yetmezlik izlendi. Ortalama geç sağkalım, endokardit, yeniden ameliyat ve tekrarlayan ciddi mitral yetmezlikten bağımsızlık oranı sırasıyla %92±0.03, %98.5±0.07, %98.1±0.01 ve %94.7±0.02 idi. Sonuç: Çalışma sonuçlarımız mitral kapak onarımının deneyimli merkezlerde uzun dönem olumlu sonuçlar ile ilişkili olarak, güvenli ve etkin bir yöntem olduğunu göstermektedir.

Durability of mitral valve repair: A single center experience

Background: This study aims to present clinical outcomes ofmitral valve repair in patients with different etiologies.Methods: Between June 2006 and August 2017, a total of 421consecutive patients (266 males, 155 females; mean age 53.1±15.6years; range, 5 to 89 years) who underwent mitral valve repair withor without concomitant cardiac procedures were retrospectivelyanalyzed. All pre-, intra-, and postoperative data were collected.Echocardiographic examinations were performed at dischargeand during follow-up. Kaplan-Meier analysis was used to estimateoverall survival and from residual severe mitral regurgitation,endocarditis and reoperation-free survival rates.Results: The mean follow-up was 58.9±35.1 months. Of the patients,12 (2.8%) had previous cardiac operations. The most predominantpathology was degenerative disease in 265 patients (62.9%).Repair techniques included ring annuloplasty (n=366, 86.9%),artificial chordae implantation (n=185, 44%), and commissurotomy(n=38, 9%). Overall in-hospital mortality rate was 1.2% (n=5).Echocardiography before discharge showed no/trivial mitralregurgitation in 64.9% (n=270) and mild mitral regurgitationin 34.85% (n=145) of the patients. At the late postoperativeperiod, transthoracic echocardiography revealed moderate mitralregurgitation in 23 patients (5.7%) and severe in 11 patients(2.7%). The mean late survival and freedom from endocarditis,reoperation, and recurrent severe mitral regurgitation rates were92±0.03%, 98.5±0.07%, 98.1±0.01%, and 94.7±0.02%, respectively.Conclusion: Our study results suggest that mitral valve repairis a safe and effective procedure associated with favorable longtermoutcomes in experienced centers.

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