Serdar BAYRAK, Cengiz ÖZBEK, Engin TULUKOĞLU, Bülent PAMUK, Türkan ÖZDEMİR, Bilgin EMECAN, İbrahim ÖZSÖYLER, Ali GÜRBÜZ

St. Jude ve CarboMedics aortik mekanik kalp kapak protezlerinin sol ventrikül fonksiyonlarına etkileri: Orta dönem sonuçlar

Aort pozisyonuna takılan St. Jude ve CarboMedics marka aort mekanik kalp kapaklarının birinci yıl sonunda sol ventrikül fonksiyonları ve boyutlarına olan etkileri araştırıldı. Çalışma planı: Çalışmaya, izole aort kapak hastalığı nedeniyle aort kapak replasmanı (AKR) yapılan 41 hasta alındı. Yirmi iki hastaya (15 erkek, 7 kadın; ort. yaş 41) St. Jude, 19 hastaya (12 erkek, 7 kadın; ort. yaş 43) CarboMedics bileaflet mekanik aort kapağı takıldı. Hastalar birinci yılın sonunda, fonksiyonel kapasite ve ekokardiyografide sol ventrikül fonksiyonu ve boyutları açısından değerlendirildi.Bulgular: Hiçbir hastada mortalite görülmedi. 19 ve 25 no St. Jude ve CarboMedics kapaklarının takıldığı gruplarda ameliyat sonrası sonuçlar, ameliyat öncesine göre anlamlı farklılık göstermedi (p>0.05). 21 no kapak takılan gruplarda, NYHA fonksiyonel sınıfı, sol ventrikül diyastol sonu çapı (SVDSÇ), ve sol ventrikül kütle indeksi (SVKİ) her iki protez ile de anlamlı düzelme gösterdi; ayrıca, sol ventrikül sistol sonu çapı (SVSSÇ), interventriküler septum kalınlığı (İVS) ve arka duvar kalınlığı (ADK) CarboMedics kapaklarla anlamlı düzelme sergiledi. 23 no kapak takılan gruplarda ameliyat sonrası anlamlı düzelme elde edilen parametreler St. Jude grubunda NYHA sınıfı, SVDSÇ, SVSSÇ ve SVKİ; CarboMedics grubunda NYHA sınıfı, SVDSÇ, ADK ve SVKİ idi. Genel değerlendirmede, St. Jude grubunda SVKİ ameliyat öncesine göre ortalama %21.4, CarboMedics grubunda ise %25.3 gerileme gösterdi. Bu açıdan iki grup arasında anlamlı fark bulunmadı.Sonuç: İzole AKR uygulanan hastalarda ilk yıl içinde, kapak numarasına bağlı olarak, sol ventrikül fonksiyonları düzelmekte, boyutları azalmakta ve hastaların fonksiyonel kapasitesi artmaktadır. St. Jude ve CarboMedics kapakları arasında bu açıdan anlamlı farklılık bulunmamaktadır

The effect of St. Jude and CarboMedics mechanical aortic valve prostheses on left ventricular function: midterm results

Background: We investigated the effect of mechanical valve implantation in the aortic position with St. Jude and CarboMedics valves on left ventricular function and dimensions at the end of the first postoperative year. Methods: Forty-one patients underwent aortic valve replacement (AVR) for isolated aortic valve disease. Of these, 22 patients (15 males, 7 females; mean age 41 years) and 19 patients (12 males, 7 females; mean age 43 years) received St. Jude and CarboMedics bileaflet mechanical valves, respectively. The patients were assessed with regard to functional capacity and echocardiographic left ventricular function and dimensions at the end of the first postoperative year.Results: There was no mortality. Postoperative findings did not differ significantly with 19-mm and 25-mm St. Jude and CarboMedics bileaflet mechanical valves (p>0.05). With 21-mm St. Jude and CarboMedics valves, NYHA functional class, left ventricular end-diastolic (LVED) diameter, and left ventricular mass index (LVMI) improved significantly; in addition, improvements in left ventricular endsystolic diameter (LVES), interventricular septum thickness (IVS), and posterior wall thickness were significant with CarboMedics valves. Implantation of 23-mm valves was associated with significant improvements in NYHA functional class, LVED and LVES diameters, and LVMI with St. Jude valves, and in NYHA functional class, LVED diameter, posterior wall thickness, and LVMI in CarboMedics valves. Overall improvement in LVMI did not differ significantly between St. Jude and CarboMedics valves, being 21.4% and 25.3%, respectively.Conclusion: Our data suggest that AVR for isolated aortic valve disease improves left ventricular functions and dimensions, and increases functional capacity of patients depending on the valve size and regardless of the kind of prosthesis used.

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) Carabello BA, Zile MR, Tanaka R, Cooper G 4th. Left ventricular hypertrophy due to volume overload versus pressure overload. Am J Physiol 1992;263(4 Pt 2):H1137-44.
2) Grossman W. Cardiac hypertrophy: useful adaptation or pathologic process? Am J Med 1980;69:576-84.
3) Maselli D, Pizio R, Bruno LP, Di Bella I, De Gasperis C. Left ventricular mass reduction after aortic valve replacement: homografts, stentless and stented valves. Ann Thorac Surg 1999;67:966-71.
4) Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977;55:613-8.
5) Sutton M, Plappert T, Spiegel A, Raichlen J, Douglas P, Reichek N, et al. Early postoperative changes in left ventricular chamber size, architecture, and function in aortic stenosis and aortic regurgitation and their relation to intraoperative changes in afterload: a prospective two-dimensional echocardiographic study. Circulation 1987;76:77-89.
6) Panidis IP, Kotler MN, Ren JF, Mintz GS, Ross J, Kalman P. Development and regression of left ventricular hypertrophy. J Am Coll Cardiol 1984;3:1309-20.
7) Harpole DH, Jones RH. Serial assessment of ventricular performance after valve replacement for aortic stenosis. J Thorac Cardiovasc Surg 1990;99:645 50.
8) Christakis GT, Joyner CD, Morgan CD, Fremes SE, Buth KJ, Sever JY, et al. Left ventricular mass regression early after aortic valve replacement. Ann Thorac Surg 1996;62:1084-9.
9) Lee JW, Choi KJ, Lee SG, Choo SJ, Kim JO, Kang DH, et al. Left ventricular muscle mass regression after aortic valve replacement. J Korean Med Sci 1999;14:511-9.
10) Autschbach R, Walther T, Falk V, Kostelka M, Rosler A, Langebartels G, et al. Prospectively randomized comparison of different mechanical aortic valves. Circulation 2000; 102(19 Suppl 3):III1-4.
11) Izzat MB, Birdi I, Wilde P, Bryan AJ, Angelini GD. Comparison of hemodynamic performances of St. Jude Medical and CarboMedics 21 mm aortic prostheses by means of dobutamine stress echocardiography. J Thorac Cardiovasc Surg 1996;111:408-15.