Hasan SUNAR, Mehmet ÖZKÖKELİ, Fuat BÜYÜKBAYRAK, Altuğ TUNCER, Ahmet ŞAŞMAZEL, Hasan ERDEM, Eylem TUNCER, Ayşe BAYSAL

Our surgical experience and mid-term results with the Senning procedure

Amaç: Büyük arter transpozisyonu (TGA) tanısı ile ameliyat edilen bebek hastalarda Senning işleminin orta dönem cerrahi sonuçları değerlendirildi. Çalışma planı: Büyük arter d-transpozisyonu (d-TGA) tanısı ile ameliyat edilen yedi hasta (ort. yaş 23.6±32.5 ay; dağılım 6-96 ay ve ort. ağırlık 9.6±4.6 kg; dağılım 7-20 kg) çalışmaya dahil edildi. Yedi hastanın üçünde basit TGA ve atriyal septal defekt gözlendi, kalan dört hastada ise kompleks TGA (ventriküler septal defekt ve pulmoner stenozlu) vardı. Senning ameliyatı öncesi dört hastada (%57) balon atriyal septostomi yapılmış idi. Ortalama ameliyat öncesi pulmoner arter basıncı 34.6±27.5 mmHg idi. Ameliyat öncesi ortalama sistemik arteriyel oksijen satürasyonu yüzde 76.3±9.2 idi. Ameliyat öncesi New York Heart Association (NYHA) sınıflandırması altı hastada (%86) fonksiyonel sınıf II ve bir hastada (%14) sınıf III idi. Retrospektif olarak analiz edilen parametreler kardiyopulmoner bypass zamanını, aortik kros klemp zamanını, mekanik ventilasyonu süresini ve yoğun bakımda kalma süresini içermekteydi.Bulgular: Bir hasta (%14) ameliyat sonrasında hastanede kaybedildi. Ortalama kardiyopulmoner bypass zamanı 155.9±23.6 dakika ve aortik kros klemp zamanı 99.9±23.5 dakika idi. Ameliyat sonrasında komplet atrioventriküler blok gelişen ve kalıcı pacemaker yerleştirilen bir hasta dışında tüm hastalar normal sinus ritminde kaldı. Bir hastada hafif süperiyor vena kava baffle obstrüksiyonu gelişti ve ortalama gradyan 2 mmHg olarak ölçüldü. Ortalama takip süresi 20.4±18.3 ay idi. Beş hasta (%84) NYHA fonksiyonel sınıflandırmasına göre sınıf I olarak değerlendirildi.Sonuç: İnfant döneminde d-TGA'lı hastalarda gerçekleştirilen Senning işlemi düşük mortalite ve morbidite oranları ile orta dönemde izlem sürecinde güvenli bir ameliyattır.

Senning işlemiyle elde ettiğimiz cerrahi deneyimimiz ve orta dönem sonuçlarımız

Background: This study aims to evaluate the mid-term surgical results of Senning procedure in infant patients with transposition of great arteries (TGA). Methods: Seven patients (mean age 23.6±32.5 months; range 6 to 96 months and mean weight 9.6±4.6 kg; range 7 to 20 kg) who underwent operation with the diagnosis of d-transposition of great arteries (d-TGA) were included in the study. Simple TGA with atrial septal defect was observed in three of the seven patients and in the remain four patients complex TGA (ventricular septal defect and pulmonary stenosis) was present. Before Senning operation, four (57%) patients had undergone balloon atrial septostomy. Mean preoperative pulmonary arterial pressure was 34.6±27.5 mmHg. Mean preoperative systemic arterial oxygen saturation was 76.3±9.2 percent. Preoperatively, New York Heart Association (NYHA) functional class II was observed in six (86%) patients and class III in one (14%) patient. The retrospectively analyzed parameters included cardiopulmonary bypass time, aortic cross-clamp time, mechanical ventilation duration, and intensive care unit stay.Results: One (14%) patient died in the hospital after the operation. Mean cardiopulmonary bypass time was 155.9±23.6 minutes and aortic cross-clamp time was 99.9±23.5 minutes. Postoperatively all patients remained in normal sinus rhythm, except for one patient who developed complete atrioventricular block and this patient required a permanent pacemaker. Mild superior vena cava baffle obstruction developed in one patient with a mean gradient of 2 mmHg. The mean follow-up was 20.4±18.3 months. Five (84%) patients were classified as class I according to the NYHA functional classification.Conclusion: Senning procedure performed in patients with d-TGA during infancy period is a safe operation with low mortality and morbidity rates in the mid-term follow-up.

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