İleri yaş ciddi aort darlığı tedavisinde mekanik aort kapak ve dikişsiz biyolojik aort kapağın sonuçlarının retrospektif karşılaştırılması
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Tarih
2020
Yazarlar
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: İleri yaş ciddi aort darlığının cerrahi tedavisinde konvansiyonel aort kapak replasmanına alternativ olarak dikiş kullanılmadığı için operasyon süresini kısaltan dikişsiz biyolojik aort kapakları kullanılmaktadır. Özellikle ek hastalıkları olan, euroscore'u yüksek veya ek kardiak cerrahi girişimler yapılacak olan hastalar için kross klemp ve KPB süreleri önemlidir. Çalışmamızda 65 yaş üstü hastalarda yapılan mekanik aort kapak ve dikişsiz biyolojik aort kapak operasyonlarının erken dönem sonuçlarının karşılaştırılması amaçlanmaktadır. Metod: Ocak 2014 ve Ekim 2019 tarihleri arasında aort darlığı tanısı ile mekanik aort kapak veya dikişsiz biyolojik aort kapak replasmanı yapılan 65 yaş ve üstü hastalar çalışmaya dahil edildi. Ek olarak mitral kapak, asendan aort girişimi olan ve aort yetmezliği tanısı ile opere edilen hastalar çalışma dışında tutuldu. Ek girişim olarak koroner bypass uygulanan toplam 50 hasta çalışmaya dahil edildi. Hastaların preoperatif özellikleri, KPB ve cross klemp süreleri, postoperatif yoğun bakım ve hastanede yatış süreleri, mortalite ve morbiditeleri karşılaştırıldı. Bulgular: Çalışmaya 72 mekanik AVR, 59 Perceval S dikişsiz biyolojik aort kapak uygulanan toplam 131 hasta dahil edildi. Dikişsiz aort kapak yapılan hastaların preoparatif yaş ve euroscore değerleri anlamlı olarak yüksek görülmesine rağmen postoperatif yoğun bakım ve hastane yatış süreleri 2grup arasında benzer sonuçalndı. Dikişsiz aort kapak yapılan hastaların KPB ve cross klemp süreleri anlamlı olarak daha düşük görüldü. Dikişsiz biyolojik aort kapak grubunda anlamlı olarak trombositopeni gelişmesine rağmen erken dönemde minör veya majör kanamalar arasında bir fark saptanmadı. Sonuç: Dikişsiz aort kapak replasmanı KPB ve kross klemp sürelerini kısaltmaktadır. Yoğun bakımda ve hastanede yatış süresi, kanama miktarı, mekanik ventilatör destek süresi üzerinde anlamlı bir etkisi yoktur.
Introduction: Sutureless biological aortic valve protheses provide an alternative to conventional aortic prosthesis in elderly patients given their shorter operative times for implantation. Aortic cross clamp and CPB times are particularly important for elderly patients with multiple comorbidities and high euroscores and for those who will be undorgoing concomitant cardiac interventions during the same operative session. This study aims to compare the early post-operative results in patients >65 years old who underwent conventional mechanical aortic valve vs. sustureless biological aortic valve implantation. Methods: Patients older than 65 years old who underwent either conventional mechanical or sutureless biological aortic valve implantation for the management of aortic stenosis between January 2014 and October 2018 were included to the study. Patients who received a concomitant mitral or ascending aortic intervention and those with a diagnosis of aortic insufficiency were excluded from the study. 50 patients who underwent CABG within the same opreative session were included to the analysis. Preoperative descriptive variables, CPB & X-clamp times, postoperative length of stay in the ICU & hospital, mortality and morbidity were compared within the two groups. Results: 131 patients were included to the final analysis from which 72 were implanted with a mechanical Ao valva and 59 with a sutureless biological valve. Postoperative ICU & Hospital stay were similar between the two groups despite thesignificantly higher age and euroscore values in the sutureless valve group. Sutureless biological valve implantation was associated with significantly shorter X-clamp and CPB times. Although patients implanted with a sutureless valve had significantly lower platelets levels, no difference in major or minor bleeding events were noted. Conclusion: Sutureless aortic valve implantation shortens CPB and X-clamp times whereas it does not have significant impact on ICU & hospital stay, bleeding events or need for mechanical ventilation.
Introduction: Sutureless biological aortic valve protheses provide an alternative to conventional aortic prosthesis in elderly patients given their shorter operative times for implantation. Aortic cross clamp and CPB times are particularly important for elderly patients with multiple comorbidities and high euroscores and for those who will be undorgoing concomitant cardiac interventions during the same operative session. This study aims to compare the early post-operative results in patients >65 years old who underwent conventional mechanical aortic valve vs. sustureless biological aortic valve implantation. Methods: Patients older than 65 years old who underwent either conventional mechanical or sutureless biological aortic valve implantation for the management of aortic stenosis between January 2014 and October 2018 were included to the study. Patients who received a concomitant mitral or ascending aortic intervention and those with a diagnosis of aortic insufficiency were excluded from the study. 50 patients who underwent CABG within the same opreative session were included to the analysis. Preoperative descriptive variables, CPB & X-clamp times, postoperative length of stay in the ICU & hospital, mortality and morbidity were compared within the two groups. Results: 131 patients were included to the final analysis from which 72 were implanted with a mechanical Ao valva and 59 with a sutureless biological valve. Postoperative ICU & Hospital stay were similar between the two groups despite thesignificantly higher age and euroscore values in the sutureless valve group. Sutureless biological valve implantation was associated with significantly shorter X-clamp and CPB times. Although patients implanted with a sutureless valve had significantly lower platelets levels, no difference in major or minor bleeding events were noted. Conclusion: Sutureless aortic valve implantation shortens CPB and X-clamp times whereas it does not have significant impact on ICU & hospital stay, bleeding events or need for mechanical ventilation.
Açıklama
Anahtar Kelimeler
Aort Darlığı, Aort Kapak Replasmanı, Dikişsiz Aort Kapak, Mekanik Aort Kapak, Aortic Stenosis, Aortiv Valve Replacement, Sutureless Aortic Valve, Mechanical Aortic Valve
