Kaan KIRALİ, Cevat YAKUT, Hasan EKİM, Veysel KUTAY

Postoperatif erken dönem mekanik mitral kapak trombozları: 5 farklı tip protezin analizi

Amaç: Mekanik mitral protez kapak trombozları sık görülmemekle birlikte, çok ciddi klinik sonuçlar doğurabilen, morbidite ve mortalitesi yüksek komplikasyonların başında gelmektedir. Bu çalışmada kliniğimizde kullanılmış olan beş farklı tip ve modeldeki mekanik mitral protezlerin, postoperatif dönemde trombotik obstrüksiyon ve trombo emboli gelişme sıklıkları değerlendirilmiştir. Materyal ve Metod: Ocak 2000 ile Şubat 2003 tarihleri arasında Van Yüksek İhtisas Hastanesi'nde mitral kapak replasmanı (MVR) gerçekleştirilen 138 olgu takılan protezin tipine göre bileaflet [St. Jude (39 hasta), Sorin Bicarbon (41 hasta), TRI (22 hasta)] ve monoleaflet [Bjork-Shiley (19 hasta), Omnicarbon (17 hasta)] olmak üzere iki gruba ayrılarak retrospektif olarak incelendi. Bulgular: Operatif mortalite bileaflet ve monoleaflet grup için sırasıyla %4.9 ile %5.5, kapağa bağlı geç dönem mortalite sırasıyla %7.2 ile %8.8 (p > 0.05) idi. Mekanik kapak trombotik obstrüksiyon oranları bileaflet grup için [St. Jude (2), Sorin (0), TRI (5); toplam 7 hasta], monoleaflet grup için [Omnicarbon (1), Bjork-Shiley (5); toplam 6 hasta] olarak bulundu (p < 0.01). Bileaflet ve monoleaflet gruptan 3'er hastaya trombolitik tedavi, bileaflet gruptan 2 ve monoleaflet gruptan 3 hastaya re-operasyon gerçekleştirildi. Mekanik kapak trombozu ve tromboemboliye bağlı ölüm oranları St.Jude için %2.7, Sorin için %0, TRI için %15.7, Omnicarbon için %0, Bjork-Shiley için %11.1 olarak bulundu. Sonuç: Bu çalışma sonucunda, bileaflet gruptan TRI ve monoleaflet gruptan Bjork-Shiley marka protezlerin tromboz ve tromboemboli gelişme insidanslarının postoperatif 1.4 ± 0.6 yıl için diğer üç proteze göre anlamlı olarak yüksek olduğu görülmüştür (p < 0.01).

Thrombosis of mechanical mitral valves in early postoperative period: The analysis of five different types of prostheses

Background: Thrombotic obstruction is an uncommon major fatal complication of the mechanical mitral valve prostheses which is leading very serious clinical results. We assessed the thrombotic occlusion and thromboembolic incidence of five different types of mechanical mitral prostheses that we had used in our clinic. Methods: Between January 2000 and February 2003, 138 patients recieved bileaflet [(St. Jude (39), Sorin Bicarbon (41), TRI (22)] or monoleaflet [Omnicarbon (17), Bjork-Shiley (19)] mechanical mitral prostheses in Van Yüksek Ihtisas Hospital. Results: The operative mortality (4.9% versus 5.5%, respectively) and late mortality (7.2% versus 8.8%, respectively) in bileaflet and monoleaflet groups were not significantly different. The incidences of thrombotic occlusion were 5.5%, 0%, 26.3%, 6.2%, 16.6% for St. Jude, Sorin, TRI, Omnicarbon and Bjork-Shiley, respectively. Thrombolytic treatment was given to six patients [Bileaflet (3), Monoleaflet (3)], and urgent re-operation was performed in five patients [Bileaflet (2), Monoleaflet (3)]. The mortality rates of prosthetic valve thrombosis were 2.7%, 0%, 15.7%, 0%, 11.1% for St. Jude, Sorin, TRI, Omnicarbon and Bjork-Shiley, respectively. Conclusion: This study suggest that the thrombotic and thromboembolic incidence of TRI and Bjork-Shiley prostheses are significantly higher than the other three prostheses for postoperative 1.4 ± 0.6 year period (p < 0.01).

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