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Biliflet Prolapsusu Olan Hastalarda Mitral Kapak Tamirinin Postoperatif Sonuçları

Yıl 2023, Cilt: 33 Sayı: 2, 154 - 161, 30.04.2023
https://doi.org/10.54005/geneltip.1217843

Öz

Giriş
Günümüzde mitral kapak onarım teknikleri, özellikle dejeneratif hastalığı olan hastalarda neredeyse tamamen mitral kapak replasmanının yerini almaktadır. Cerrahların çoğu biliflet prolapsusu olan hastalarda onarımı tercih etmekten çekinmektedir. Bu çalışmada mitral kapak yetmezliği olan ve biliflet prolapsusu nedeniyle onarım teknikleri ile tedavi edilen hastalarımızın ameliyat sonrası sonuçlarını araştırmayı amaçladık.
Metodlar
Bu çalışmaya Ocak 2006-Ocak 2016 tarihleri arasında Türkiye Yüksek İhtisas Hastanesi'nde biliflet prolapsus nedeniyle aynı cerrahi ekip tarafından mitral kapak tamiri yapılan 89 hasta dahil edildi. Mortalite, tekrarlayan mitral yetmezlik, ekokardiyografik parametreler ve tekrar operasyon oranları gibi preoperatif, operatif ve postoperatif veriler araştırıldı.

Bulgular
Ortalama takip süresi 25,3±17,7 aydı. Ortalama yaş 46,6±17,4 idi. Transtorasik ekokardiyografik değerlendirmelere göre 8 (%9) hastada orta, 81 (%91) hastada ciddi mitral yetmezlik vardı. Preoperatif ve postoperatif değerler karşılaştırıldığında, NYHA sınıflamasına göre hastaların fonksiyonel kapasitelerinde istatistiksel olarak anlamlı iyileşme kaydedilmiştir. (2,1±0,5 ; 1, , p=0,001) Sol ventrikül diyastol sonu çapında (5,5±0,7 cm ; 5±0,6 cm, p=0,001), sol ventrikül sistol sonu çapında (3,8±0,6 cm ; 3,6±0,6 cm, p=0,004), sol atriyum çapı (4,8±0,9 cm; 4,3±0,6 cm, p=0,001) ve pulmoner arter basıncındaki (44,3±13,4 mmHg; 32,1±5,4 mmHg, p=0,001) düzelemeler istatistiksel olarak anlamlıydı.

Sonuç
İyi postoperatif sonuçlar ve dayanıklılık oranları göz önünde bulundurularak, özellikle sütür teknolojilerindeki gelişmelerle mümkün olabilen korda replasman tekniği ile bileaflet prolapsusa bağlı mitral kapak yetmezliği olan hastalarda mitral kapak onarımı güvenle kullanılabilir.

Kaynakça

  • Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American college of cardiology/American Heart Association Task Force on practice guidelines. Circulation 2014;129:2440–92.
  • Sand ME, Naftel DC, Blackstone EH et al. A comparison of repair and replacement for mi- tral valve incompetence. J Thorac Cardiovasc Surg 1987;94:208.
  • Tribouilloy C, Enriquez-Sarano M, Schaff H et al. Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation : rationale for optimizing surgical indications. Circulation 1999;99:400–5
  • Suri RM, Schaff H, Dearani JA et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg 2006;82:819–26.
  • Gillinov A, Cosgrove D, Blackstone E et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg 1998;116:734–43.
  • Rankin JS, Orozco RE, Rodgers TL, Alfery DD, Glower DD. ‘‘Adjustable’’ artificial chordal replacement for repair of mitral valve prolapse. Ann Thorac Surg 2006;81:1526-8.
  • Lawrie GM, Earle EA, Earle NR. Feasibility and intermediate term outcome of repair of prolapsing anterior mitral leaflets with artificial chordal replacement in 152 patients. Ann Thorac Surg 2006;81:849–56.
  • Hataa H, Fujitaa T, Shimaharaa Y, Satoa S, Ishibashi-Uedab H and Kobayashia J. A 25-year study of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair. Interactive CardioVascular and Thoracic Surgery 2015;20:463–9
  • Lung B, Baron G, Butchart EG et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003;24:1231-43.
  • Jokinen JJ, Hippelainen MJ, Pitkanen OA, Hartikainen JE. Mitral valve replacement versus repair: propensity-adjusted survival and quality-of-life analysis. Ann Thorac Surg 2007; 84:451-8
  • David TE, Armstrong S, McCrindle BW, Manlhiot C. Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease.Circulation 2013;127:1485–92.
  • Castillo JG, Anyanwu AC, Fuster V, Adams DH. A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines. J Thorac Cardiovasc Surg 2012;144:308–12.
  • David TE, Ivanov J, Armstrong S, Christie D, Rakowski H. A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse. J Thorac Cardiovasc Surg 2005;130:1242-9.
  • Cagli K. A simple method of making artificial chordal loops for mitral valve repair. Ann Thorac Surg 2010;89:12-4.
  • Cagli K, Yalcinkaya A, Lafci G, Ulas MM, Tasoglu I. A Modified approach: Chordal transfer together with shortening. Asian Cardiovasc Thorac Ann 2011;19:175-6.
  • Gillinov AM, Blackstone EH, Alaulaqi A et al. Outcomes after repair of the anterior mitral leaflet for degenerative disease. Ann Thorac Surg 2008;86:708-17.
  • Okada Y, Nasu M, Koyama T et al. Outcomes of mitral valve repair for bileaflet prolapse. The Journal of Thoracic and Cardiovascular Surgery 2012;143:21-3.
  • DiBardino DJ, ElBardissi AW, McClure RSet al. Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution, and long-term outcome. The Journal Thorac Cardiovasc Surg 2010;139:76-84.
  • David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: a 25-year experience. J Thorac Cardiovasc Surg 2013;145:1563–9.
  • Mohty D, Orszulak TA, Schaff HV, Avierinos JF, Tajik JA, Enriquez-Sarano M. Very long-term survival and durability of mitral valve repair for mitral valve prolapse. Circulation 2001;104:1–7.
  • Frater RW. Assumptions and realities of mitral valve repair. J Heart Valve Dis 2003;12:11–3.
  • Pfannmüller B, Seeburger J, Misfeld M, Borger MA, Garbade J, Mohr FW. Minimally invasive mitral valve repair for anterior leaflet prolapse. J Thorac Cardiovasc Surg 2013;146:109–13.
  • Carpentier A, Chauvad S, Fabiani JN et al. Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg 1980;79:338-48.
  • Frater RWM. Mitral valvuloplasty. In: Roberts AJ, Conti CR (eds) Current surgery of the heart. Philadelphia: Lippincott, 1987, 62–77.
  • Smedira NG, Selman R, Cosgrove DM et al. Repair of anterior leaflet prolapse: chordal transfer is superior to chordal shortening. J Thorac Cardiovasc Surg 1996;112:287–292.
  • Carpentier AF, Lessana A, Relland JY et al: The “physio-ring”: an advanced concept in mitral valve annuloplasty, Ann Thorac Surg 1995;60:1177-86.
  • Okada Y, Shomura T, Yamaura Y, Yoshikawa J. Comparison of the Carpentier and Duran prosthetic rings used in mitral reconstruction. Ann Thorac Surg 1995;59:658-63.
  • Gillinov AM, Cosgrove DM, Wahi S et al.Is anterior leaflet repair always necessary in repair of bileaflet mitral valve prolapse?.Ann Thorac Surg 1999;68:820–3.
  • Gonçalo FC, Correia PM, Branco C, Antunes MJ. Long-term results of mitral valve surgery for degenerative anterior leaflet or bileaflet prolapse: analysis of negative factors for repair, early and late failures, and survival. European Journal of Cardio-Thoracic Surgery 2016;50:66-74.
  • Bellitti R, Petrone G, Buonocore M, Nappi G, Santé P. Anatomic reconstruction in degenerative mitral valve bileaflet prolapse: long-term results. Ann Thorac Surg 2014;97:563-8.
  • Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J 2010;31:1958–66
  • Anyanwu AC, Bridgewater B, Adams DH. The lottery of mitral valve repair surgery. Heart 2010;96:1964–7.
  • Speziale G, Nasso G, Esposito G et al. Results of mitral valve repair for Barlow disease (bileaflet prolapse) via right minithoracotomy versus conventional median sternotomy: a randomized trial. J Thorac Cardiovasc Surg 2011;142:77–83.

Postoperative Outcomes of Mitral Valve Repair in Patients with Bileaflet Prolapse

Yıl 2023, Cilt: 33 Sayı: 2, 154 - 161, 30.04.2023
https://doi.org/10.54005/geneltip.1217843

Öz

Background
Today, repair techniques almost completely take place of the mitral valve replacement, especially in patients with degenerative disease. Majority of the surgeons hesitate to prefer repair in patients with bileaflet prolapse. In this study we aimed to investigate postoperative results of our patients with mitral valve insufficiency due to bileaflet prolapse and treated with repair techniques

Methods
89 patients who underwent mitral valve repair by the same surgical team due to bileaflet prolapse, between January 2006 and January 2016 in Turkiye Yuksek Ihtisas Hospital were included to this study. Preoperative, operative and postoperative data such as mortality, recurrent mitral insufficiency, echocardiographic parameters and reoperation rates were investigated.

Results
Mean follow up duration was 25.3±17.7 months. Mean age was 46.6±17.4 years. According to the transthoracic echocardiographic evaluations, 8 (9%) patients had moderate and 81 (91%) patients had severe mitral insufficiency. When preoperative and postoperative values were compared statistically significant improvement in functional capacity of patients according to NYHA classification has been noted. (2.1±0.5 ; 1, , p=0.001) Improvements in left ventricular end diastolic diameter (5.5±0.7 cm ; 5±0.6 cm, p=0.001), left ventricular end sistolic diameter (3.8±0.6 cm ; 3.6±0.6 cm, p=0.004 ), left atrium diameter (4.8±0.9 cm ; 4.3±0.6 cm, p=0.001) and pulmonary artery pressure (44.3±13.4 mmHg; 32.1±5.4 mmHg, p=0.001) were statistically significant.
Conclusions
In the lights of findings about good postoperative results and durability rates, mitral valve repair can be safely used in patients with mitral valve insufficiency due to bileaflet prolapse especially with chordae replacement technique which can be feasible after improvements in suture technologies.

Kaynakça

  • Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/ ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American college of cardiology/American Heart Association Task Force on practice guidelines. Circulation 2014;129:2440–92.
  • Sand ME, Naftel DC, Blackstone EH et al. A comparison of repair and replacement for mi- tral valve incompetence. J Thorac Cardiovasc Surg 1987;94:208.
  • Tribouilloy C, Enriquez-Sarano M, Schaff H et al. Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation : rationale for optimizing surgical indications. Circulation 1999;99:400–5
  • Suri RM, Schaff H, Dearani JA et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg 2006;82:819–26.
  • Gillinov A, Cosgrove D, Blackstone E et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg 1998;116:734–43.
  • Rankin JS, Orozco RE, Rodgers TL, Alfery DD, Glower DD. ‘‘Adjustable’’ artificial chordal replacement for repair of mitral valve prolapse. Ann Thorac Surg 2006;81:1526-8.
  • Lawrie GM, Earle EA, Earle NR. Feasibility and intermediate term outcome of repair of prolapsing anterior mitral leaflets with artificial chordal replacement in 152 patients. Ann Thorac Surg 2006;81:849–56.
  • Hataa H, Fujitaa T, Shimaharaa Y, Satoa S, Ishibashi-Uedab H and Kobayashia J. A 25-year study of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair. Interactive CardioVascular and Thoracic Surgery 2015;20:463–9
  • Lung B, Baron G, Butchart EG et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003;24:1231-43.
  • Jokinen JJ, Hippelainen MJ, Pitkanen OA, Hartikainen JE. Mitral valve replacement versus repair: propensity-adjusted survival and quality-of-life analysis. Ann Thorac Surg 2007; 84:451-8
  • David TE, Armstrong S, McCrindle BW, Manlhiot C. Late outcomes of mitral valve repair for mitral regurgitation due to degenerative disease.Circulation 2013;127:1485–92.
  • Castillo JG, Anyanwu AC, Fuster V, Adams DH. A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines. J Thorac Cardiovasc Surg 2012;144:308–12.
  • David TE, Ivanov J, Armstrong S, Christie D, Rakowski H. A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse. J Thorac Cardiovasc Surg 2005;130:1242-9.
  • Cagli K. A simple method of making artificial chordal loops for mitral valve repair. Ann Thorac Surg 2010;89:12-4.
  • Cagli K, Yalcinkaya A, Lafci G, Ulas MM, Tasoglu I. A Modified approach: Chordal transfer together with shortening. Asian Cardiovasc Thorac Ann 2011;19:175-6.
  • Gillinov AM, Blackstone EH, Alaulaqi A et al. Outcomes after repair of the anterior mitral leaflet for degenerative disease. Ann Thorac Surg 2008;86:708-17.
  • Okada Y, Nasu M, Koyama T et al. Outcomes of mitral valve repair for bileaflet prolapse. The Journal of Thoracic and Cardiovascular Surgery 2012;143:21-3.
  • DiBardino DJ, ElBardissi AW, McClure RSet al. Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution, and long-term outcome. The Journal Thorac Cardiovasc Surg 2010;139:76-84.
  • David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: a 25-year experience. J Thorac Cardiovasc Surg 2013;145:1563–9.
  • Mohty D, Orszulak TA, Schaff HV, Avierinos JF, Tajik JA, Enriquez-Sarano M. Very long-term survival and durability of mitral valve repair for mitral valve prolapse. Circulation 2001;104:1–7.
  • Frater RW. Assumptions and realities of mitral valve repair. J Heart Valve Dis 2003;12:11–3.
  • Pfannmüller B, Seeburger J, Misfeld M, Borger MA, Garbade J, Mohr FW. Minimally invasive mitral valve repair for anterior leaflet prolapse. J Thorac Cardiovasc Surg 2013;146:109–13.
  • Carpentier A, Chauvad S, Fabiani JN et al. Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg 1980;79:338-48.
  • Frater RWM. Mitral valvuloplasty. In: Roberts AJ, Conti CR (eds) Current surgery of the heart. Philadelphia: Lippincott, 1987, 62–77.
  • Smedira NG, Selman R, Cosgrove DM et al. Repair of anterior leaflet prolapse: chordal transfer is superior to chordal shortening. J Thorac Cardiovasc Surg 1996;112:287–292.
  • Carpentier AF, Lessana A, Relland JY et al: The “physio-ring”: an advanced concept in mitral valve annuloplasty, Ann Thorac Surg 1995;60:1177-86.
  • Okada Y, Shomura T, Yamaura Y, Yoshikawa J. Comparison of the Carpentier and Duran prosthetic rings used in mitral reconstruction. Ann Thorac Surg 1995;59:658-63.
  • Gillinov AM, Cosgrove DM, Wahi S et al.Is anterior leaflet repair always necessary in repair of bileaflet mitral valve prolapse?.Ann Thorac Surg 1999;68:820–3.
  • Gonçalo FC, Correia PM, Branco C, Antunes MJ. Long-term results of mitral valve surgery for degenerative anterior leaflet or bileaflet prolapse: analysis of negative factors for repair, early and late failures, and survival. European Journal of Cardio-Thoracic Surgery 2016;50:66-74.
  • Bellitti R, Petrone G, Buonocore M, Nappi G, Santé P. Anatomic reconstruction in degenerative mitral valve bileaflet prolapse: long-term results. Ann Thorac Surg 2014;97:563-8.
  • Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J 2010;31:1958–66
  • Anyanwu AC, Bridgewater B, Adams DH. The lottery of mitral valve repair surgery. Heart 2010;96:1964–7.
  • Speziale G, Nasso G, Esposito G et al. Results of mitral valve repair for Barlow disease (bileaflet prolapse) via right minithoracotomy versus conventional median sternotomy: a randomized trial. J Thorac Cardiovasc Surg 2011;142:77–83.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Original Article
Yazarlar

Eren Günertem 0000-0002-7132-8586

Ömer Faruk Çiçek 0000-0002-4675-3273

Serkan Mola 0000-0002-5526-5298

Ersin Kadirogulları 0000-0002-1249-4373

Halil İbrahim Erkengel 0000-0001-7034-9548

Adnan Yalçınkaya 0000-0002-0752-6553

Adem İlkay Diken 0000-0002-8782-7603

Emre Yaşar 0000-0003-2599-6521

Garip Altintas 0000-0003-2075-0143

Mahmut Ulaş 0000-0003-1867-5842

Gökhan Lafçı 0000-0002-0639-4341

Erken Görünüm Tarihi 30 Nisan 2023
Yayımlanma Tarihi 30 Nisan 2023
Gönderilme Tarihi 14 Aralık 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 33 Sayı: 2

Kaynak Göster

Vancouver Günertem E, Çiçek ÖF, Mola S, Kadirogulları E, Erkengel Hİ, Yalçınkaya A, Diken Aİ, Yaşar E, Altintas G, Ulaş M, Lafçı G. Postoperative Outcomes of Mitral Valve Repair in Patients with Bileaflet Prolapse. Genel Tıp Derg. 2023;33(2):154-61.