Nilgün BOZBUĞA, Kaan KIRALİ, Murat RABUŞ, Vedat ERENTUĞ, Esat AKINCI, Cevat YAKUT, Mustafa GÜLER, Hasan Basri ERDOĞAN, Nihan KAYALAR

Reoperation for bioprosthetic mitral valve dysfunction early and late-term risk analysis

Amaç:Mitral biyoprotez kapak replasmanı uygulanmış romatizmal kalp hastalarında biyoprotez kapak disfonksiyonu için yapılan reoperasyonların erken ve geç dönem sonuçlarını etkileyen risk faktörleri değerlendirildi ve bu ameliyatların uzun dönem seyri incelendi.Çalışma planı:1985-2004 yılları arasında biyoprotez kapak disfonksiyonu nedeniyle toplam 104 hastaya (95 kadın, 9 erkek; ort. yaş 48.5±11.3; dağılım 20-73) reoperasyon uygulandı. Biyoprotez kapak disfonksiyonu 99 hastada yapısal dejenerasyona, ikisinde enfektif endokardite ve üçünde periprostetik kaçağa bağlıydı.Bulgular:Hastane mortalitesi %8.7 (n=9) oldu. Multivariate analizde erken mortalite ile ilişkili bulunan durumlar, ilk ameliyatta triküspid kapak girişimi yapılmış olması (p=0.03; odds ratio 22.7, %95 CI 1.2-423.7), pulmoner hipertansiyon (p=0.03; odds ratio 24.8, %95 CI 1.3-475.8) ve reoperasyonlarda eşzamanlı triküspid kapak onarımı (p=0.03, odds ratio 22.7, %95 CI 1.2-423.8) olarak saptandı. İlk ameliyatta triküspid kapak girişimi uygulananlarda, uygulanmayanlara kıyasla daha kötü sonuçlar alındı (p=0.038). Geç mortalite %2.9 (n=3) oldu. Geç mortalite ile ilişkili bir risk faktörü saptanamadı. On yıllık sağkalım %85.6±4.35 idi.Sonuç:Mitral biyoprotez kapak disfonksiyonlarında reoperasyon pulmoner hipertansiyon gelişmeden önce yapılmalıdır. Hastada ilk ameliyatta ve reoperasyonda girişim gerektiren triküspid kapak patolojisi varlığı, reoperasyonun erken dönem mortalitesi üzerine etkilidir.

Mitral biyoprotez kapak disfonksiyonu reoperasyonlarında erken ve geç dönem risk analizi

Background:essment of risk factors affecting early and late outcomes of reoperation for bioprosthetic mitral valve dysfunction in patients with rheumatic heart disease and analysis of long-term prognosis of such operations.Methods: Between 1985 and 2004, we performed reoperations for bioprosthetic valve dysfunction to 104 patients (95 women, 9 men; mean age 48.5±11.3 years; range 20 to 73 years). Causes of bioprosthetic valve dysfunction were structural degeneration in 99 patients, infective endocarditis in two patients and paravalvular leak in three patients.Results: hospital mortality was 8.7% (9 patients). Multivariate analysis showed that tricuspid repair in the first operation (p=0.03; Odds ratio 22.7, 95%CI 1.2-423.7), pulmonary hypertension (p=0.03; Odds ratio 24.8, 95%CI 1.3- 475.8), and concomitant tricuspid valve repair in the reoperation (p=0.03, Odds ratio 22.7, %95CI 1.2-423.8) were significant risk factors for early mortality. Patients with initial tricuspid disease at the first operation had worse early outcome compared to patients without tricuspid pathology (p=0.038). Late mortality was 2.9% (3 patients). No statistically significant risk factor for late mortality was identified. The ten-year survival rate was 85.6%±4.35.Conclusion: study suggests that reoperation for bioprosthetic mitral valve dysfunction should be performed prior to development of pulmonary hypertension. Rheumatic tricuspid valve disease requiring repair at first operation and/or at reoperation has a poor effect on the early outcome of reoperation.

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