Takayasu arteritinde aort regürjitasyonu ve aort kapak ameliyatı: Bir meta-analiz

Amaç: Bu çalışmada Takayasu arteriti olan hastaların majör bir komplikasyonu olabilen aort regürjitasyonunun klinik özellikleri ile beraber bu hastalarda gereken aort kapak ameliyatları tanımlandı. Çalışma planı: Bu meta-analiz; literatürden erişilen, Ocak 2001 ve Aralık 2016 tarihleri arasında yayınlanan ve 159 Takayasu arteriti hastasını içeren 41 ilgili yazıya dayandırıldı. On iki erkek ve 55 kadın hasta varken 92 hastanın cinsiyet bilgisi yoktu. Bulgular: Takayasu arteriti popülasyonunun aort regürjitasyonu hastası profili; kadın cinsiyetinin, tip 2a Takayasu arteritinin ve aort regürjitasyonunun şiddetli derecesinin hakim olduğunu gösterdi. Çoğu, en yaygını aort kapak replasmanı veya kompozit greft replasmanı olmak üzere aort kapak ameliyatı gerektirdi. Eşzamanlı kalp ameliyatları içinde en sık olan koroner arter baypas greftleme idi; Takayasu arteriti kaynaklı arteriyel greft patensi endişesi nedeniyle safen ven tercih edilen bir greft seçeneği idi. Ameliyat sonrası kardiyak komplikasyonlar 31 hastada (%20.7) oluştu ve 13’ünde (%41.9) yeniden girişim gerekti. Lojistik regresyon analizi ameliyat sonrası komplikasyonlar için belirleyici risk faktörlerinin primer aort kapak ameliyatı ve eşzamanlı kalp ameliyatı olduğunu ortaya koydu. Tüm hasta popülasyonun mortalite oranı %21.5 idi. Sonuç: Takayasu arteriti aort regürjitasyonuna neden olabilir ve hastaların çoğunluğunda aort kapak ameliyatı gerekir. Ameliyat sonrası komorbidite oranı yüksektir. Ameliyat sonrası komplikasyonları ve sonraki yeniden girişimleri önlemek için aort kapak ameliyatları sırasında güçlendirici tekniklerden yararlanılması, Takayasu arteritinin aktif bir evresinde kardiyak ameliyatlardan kaçınılması ve ameliyat sonrası steroid tedavisi önerilmektedir.

Aortic regurgitation and aortic valve operation in Takayasu arteritis: A meta-analysis

Background: This study aims to describe the clinical features of aortic regurgitation, which can be a major complication of patients with Takayasu arteritis, as well as necessitated aortic valve operations in such patients.Methods: This meta-analysis was based on the literature retrieval of 41 pertinent articles including 159 Takayasu arteritis patients, published between January 2001 and December 2016. There were 12 male and 55 female patients, while gender of 92 patients was not available.Results: The aortic regurgitation patient profile of Takayasu arteritis population showed a predominance of female gender, type 2a of Takayasu arteritis, and severe degree of aortic regurgitation. Most of them warranted aortic valve operations, the most common of which were aortic valve replacements or composite graft replacements. Of the concurrent cardiac operations, coronary artery bypass grafting was the most frequent, for which the saphenous vein was a preferred graft choice due to the concern of the Takayasu arteritis-impaired arterial graft patency. Postoperative cardiac complications occurred in 31 patients (20.7%) and reintervention was warranted in 13 (41.9%). Logistic regression analysis revealed that the primary aortic valve operation and concurrent cardiac operation were the predictive risk factors of postoperative complications. The mortality rate of the entire patient population was 21.5%.Conclusion: Takayasu arteritis may cause aortic regurgitation and the majority of the patients warrant an aortic valve operation. The postoperative comorbidity rate remains high. To avoid postoperative complications and subsequent reinterventions, utilization of reinforcing techniques during aortic valve operations, avoidance of cardiac operations during an active stage of Takayasu arteritis and postoperative steroid therapy are recommended.

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