Osman TİRYAKİOĞLU, Tamer TÜRK, Cüneyt ERİŞ, Şenol YAVUZ, Gündüz YÜMÜN, A. Hakan VURAL, Hasan ARI, Selma Kenar TİRYAKİOĞLU, Ahmet F. ÖZYAZICIOĞLU, Faruk TOKTAŞ

Repeat valve surgery: An analysis of 182 patients

Amaç: Bu çalışmada, ikinci kez yinelenen kapak değişimi olgularında ameliyat öncesi ve ameliyat sırası risk faktörleri, kullanılan kapak türleri ve ameliyat yöntemleri araştırıldı. Çalışma planı: Kliniğimizde Ocak 1994 - Aralık 2009 tarihleri arasında toplam 2089 kapak replasmanı gerçekleştirildi ve bu ameliyatların 182’sini (112 kadın, 70 erkek) yinelenen kapak ameliyatları oluşturdu. Bulgular: Yinelenen ameliyat için ortalama yaş 49.2±27.4 yıl, ilk ameliyat ile ikincisi arasındaki ortalama süre ise 11.8±5.7 yıl olarak hesaplandı. Tekrar ameliyat sonrası takip süresi 2.6±1.3 yıl idi. Toplam 142 (%78) hastadan biyoprotez kapak, 40 (%22) hastadan ise mekanik kapak söküldü. Toplam değiştirilen kapak sayısı 221 idi. Toplam takılan kapak sayısı 219 idi, sadece kapak onarımı ise üç hastada uygulandı. Tekrar ameliyatta takılan kapakların 197’si (%90) mekanik kapak idi. Hastaların ameliyat öncesi ekokardiyografik bulguları, esas sorunun kapak disfonksiyonu (%84) olduğunu gösterdi, bunu enfeksiyon takip ediyordu. Yinelenen ameliyat uygulanan 15 olgu (%8.2) ameliyat sırasında veya ameliyattan sonraki ilk bir ay içinde kaybedildi. Sonuç: Yinelenen kalp kapak ameliyatları, standart ameliyat işlemleri kullanılarak, kabul edilebilir mortalite ile uygulanabilir. Bu ameliyatlarda riski artıran nedenler, acil girişimler ve enfeksiyona bağlı nedenlerdir, bununla birlikte pulmoner hipertansiyon, yinelenen kapak değişimi cerrahisi olasılığını artıran bir neden değildir.

Yinelenen kapak cerrahisi: 182 hastanın analizi

Background: In this study, we aimed to investigate the preoperative and operative risk factors in patients undergoing valve replacement for the second time, including the types of valves and surgical methods used. Methods: Between January 1994 and December 2009, a total of 2089 valve replacements were performed in our clinic, and 182 (112 females, 70 males) of these operations (8.7%) were repeat valve surgeries. Results: The mean age for repeat surgery was 49.2±27.4 years while the mean time elapsed between the first and second surgeries was 11.8±5.7 years. The follow-up period after repeat surgery was 2.6±1.3 years. Bioprosthesis valves were removed from a total of 142 patients (78%), and mechanical valves were removed from 40 patients (22%). In total, 221 valves were replaced. The total number of valves implanted was 219, and valve repair alone was performed on three patients. Of the valves implanted in repeat surgery, 197 (90%) were mechanical valves. The preoperative echocardiography findings revealed that the major problem (84%) observed was valve dysfunction, followed by infection. Fifteen patients (8.2%) who underwent repeat surgery died during the operation or within the first month afterwards. Conclusion: Repeat heart valve surgery may be performed using the standard surgical procedures with acceptable mortality. Factors increasing the probability of repeat surgery include emergency interventions and infections; however, pulmonary hypertension is not a factor that increases the probability of repeat valve replacement surgery.

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