Rezan AKSOY, Ünsal VURAL, Günseli ABAY, Mehmet KIZILAY, Fatih ÖZDEMİR, Cevdet DÖNMEZ, Serdar AKANSEL, Ahmet Yavuz BALCI

Prostetik kapak patolojisinden kaçınmak için kapak tamiri: Mitral kapak tamirinde orta dönem sonuçlar

Amaç: Bu çalışmada, mitral kapak onarımı sonuçlarımız sunuldu. Çalışma planı: Ocak 2007 - Kasım 2016 tarihleri arasında kalp merkezimizde mitral kapak tamiri yapılan toplam 128 hasta (72 erkek, 56 kadın; ort. yaş 51.8±17.2 yıl; dağılım 16-84 yıl) retrospektif olarak incelendi. Hastaların %86.7’sinde (n=111) mitral yetersizlik, %7.8’inde (n=10) mitral darlık ve %5.5'inde (n=7) mikst tip kapak hastalığı vardı. Hastaların %80.5’ine (n=103) mitral ring anuloplasti, %36.7’sine (n=47) yapay korda implantasyonu, %13.3’üne (n=17) açık mitral komissürotomi ve %6.3’üne (n=8) Alfieri işlemi uygulandı. Altmış iki hastaya (%48.8) izole mitral kapak tamiri yapılırken, geriye kalan hastalara eş zamanlı cerrahi işlemler uygulandı. Ameliyat sonrası ortalama takip süresi 52 aydı. Bulgular: Yedi hastada düşük kalp debisine bağlı erken dönem (30 günlük) mortalite görüldü. Orta dönem mortalite izlenmedi. Takip süresince 4 hastada (%3.6) çeşitli derecelerde mitral yetersizlik gözlenirken, bunların ikisi (%1.5) ileri düzeyde idi ve kapak replasmanı için yeniden ameliyat gerekti. Kapak tamirinden en fazla miksomatöz patolojili ve izole kapak tamiri uygulanan hastalar yarar gördü. Romatizmal etyolojisi olan hastalar arasında, tamirin en başarılı olduğu grup izole mitral darlık olan hastalardı. Ameliyat sonrası ekokardiyografide sol atriyum çapı ve pulmoner arter basıncında anlamlı düşüş izlendi (p

Valve repair to avoid prosthetic valve pathology: Mid-term results in mitral valve repair

Background: In this study, we aimed to present our results of mitral valve repair.Methods: Between January 2007 and November 2016, a total of 128 patients (72 males, 56 females; mean age 51.8±17.2 years; range 16 to 84 years) who underwent mitral valve repair in our heart center were retrospectively analyzed. There were mitral regurgitation in 86.7% (n=111), mitral stenosis in 7.8% (n=10), and mixed type valve disease in 5.5% of the patients (n=7). Mitral ring annuloplasty was performed in 80.5% (n=103), implantation of the artificial chordae in 36.7% (n=47), open mitral commissurotomy in 13.3% (n=17), and Alfieri procedure in 6.3% (n=8) of the patients. Sixty-two patients (48.8%) underwent isolated mitral valve repair, while concomitant surgical procedures were performed in the remaining patients. Postoperative mean follow-up was 52 months.Results: Early (30-day) mortality was observed in seven patients due to low cardiac output. There was no mid-term mortality. During follow-up, various degree of mitral regurgitation was detected in 4 patients (3.6%), regurgitation was severe in two of them and these two require reoperation with the replacement of the valve. Patients with a myxomatous valve pathology who underwent isolated valve repair most benefited from valve repair. Patients with isolated mitral stenosis were the most successful group among the patients with a rheumatic etiology. Postoperative echocardiography showed a significant decrease in the left atrial diameter and pulmonary artery systolic pressures (p

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