Buğra HARMANDAR, Türkay SARITAŞ, Ahmet ŞAŞMAZEL, Zeliha TUNCEL, İbrahim YEKELER, Mehmet Salih BİLAL, Numan Ali AYDEMİR, Ali Rıza KARACI

Sağ ventrikül çıkım yolu rekonstrüksiyonunda kullanılan kapaklı kondüitlerin erken ve orta dönem sonuçları

Amaç: Bu çalışmada sağ ventrikül çıkım yolu (SVÇY) rekonstrüksiyonu için farklı tiplerde kapaklı ksenogreftlerin kullanıldığı hastaların erken ve orta dönem sonuçları sunuldu. Çalışma planı : Temmuz 2002 - Aralık 2010 tarihleri arasında farklı tiplerde kapaklı ksenogreft kondüit kullanılarak SVÇY rekonstrüksiyonu yapılan 56 hasta (33 erkek, 23 kadın; ort. yaş 3.7 yıl; dağılım 1 ay-19 yıl) çalışmaya dahil edildi. Kullanılan kapaklı kondüitlerin çapları ortalama 16.5 mm (dağılım 11-23 mm) idi. Farklı tipte kapaklı kondüitlerden; porsin aortik kapağın implante edildiği bovin perikardiyal kondüit (LabCor, Sulzer Carbomedics) 41 hastada, bovin kapaklı juguler ven (Contegra, Medtronic) 13 hastada, gluteraldehid ile fikse edilmiş porsin aortik kapak ve kökü (Freestyle, Medtronic) ile stentsiz porsin pulmoner kapağı ihtiva eden bovin perikardiyal tüp (Shelhigh, Union) ise birer hastada kullanıldı. Bulgular: Sekiz hasta (%14.2) ameliyat sonrası erken dönemde, bir hasta (%1.8) geç dönemde kaybedildi. Ortalama 22.5 aylık (1 ay-6 yıl arası) takip süresinde 15 hastada (%31.9) kondüit stenozu gelişti. Kondüit stenozu gelişen hastaların 10unda (%21.2) hafif stenoz (ortalama gradient 26.5 mmHg), ikisinde (%4.2) orta stenoz (ortalama gradient 42 mmHg), üçünde (%6.3) ciddi kondüit stenozu (ortalama gradient 66.6 mmHg) meydana geldi. Ciddi kondüit stenozu bulunan hastaların hepsine perkütan balon anjiyoplasti uygulandı. Balon anjiyoplasti sonrası iki hastada ortalama sağ ventrikül (SV)-pulmoner arter (PA) gradienti 33 ve 37 mmHgya düştü. Balon anjiyoplasti sonrası SV-PA gradienti 50 mmHgya düşen üçüncü hastaya ise, kondüit içi stent implantasyonu uygulandı (rezidüel stenoz gradienti 30 mmHg). Sonuç : Sağ ventrikül çıkım yolu rekonstrüksiyonunda kullanılan kapaklı ksenogreftler pulmoner homogreftlere alternatif olarak görünmektedir. Bu kondüitlerin uzun dönem dayanıklılıkları yapılacak yeni çalışmalarla desteklenmelidir.

Early and midterm results of valved conduits used in right ventricular outflow tract reconstruction

Background: In this article, we present early and midterm results of patients who underwent right ventricular outflow tract (RVOT) reconstructions using different types of valved xenografts. Methods: Between July 2002 and December 2010, 56 patients (33 males, 23 females; mean age 3.7 years; range 1 month-19 years) who underwent RVOT reconstructions using different types of valved xenografts were included. The mean size of the valved conduits was 16.5 mm (range 11-23 mm). Regarding different types of valved conduits; porcine aortic valve implanted bovine pericardial conduit (LabCor, Sulzer Carbomedics), bovine valved jugular vein (Contegra, Medtronic), glutaraldehyde fixed porcine aortic valved root (Freestyle, Medtronic) and bovine pericardial tube containing stentless porcine pulmonary valve were used in 41, 13, one and one patients, respectively. Results: Eight patients (14.2%) died in early postoperative period and one patient (1.8%) died in late postoperative period. Conduit stenoses were encountered in 15 patients (31.9%) through the follow-up with a mean of 22.5 months (range 1 month to 6 years). Among the patients with conduit stenosis, mild stenosis was present in 10 (21.2%) (mean gradient 26.5 mmHg), moderate in two (4.2%) (mean gradient 42 mmHg) and severe in three patients (6.3%) (mean gradient 66.6 mmHg). Percutaneous balloon angioplasty was performed in patients with severe conduit stenosis. Following balloon angioplasty, right ventricle (RV)-pulmonary artery (PA) stenosis gradients decreased to 33-37 mmHg in two patients. Intraconduit stent implantation was required in one patient with a RV-PA gradient of 50 mmHg following balloon angioplasty (residual stenosis gradient 30 mmHg). Conclusion: Valved xenog rafts seem to bealter natives to pulmonary homografts to be used in RVOT reconstructions. Long-term durability of these conduits should be supported with further studies.

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