İSKEMİK MİTRAL YETMEZLİKTE KAPAK REPLASMANI VE TAMİR SONUÇLARININ KARŞILAŞTIRILMASI Comparison of the Surgical Results Between Valve Replacement and Repair in the Treatment of Mitral Insufficieny

Year 2019, Volume: 9 Issue: 4, 1 - 5, 27.12.2019

Veysel Başar , Ertekin Utku Ünal Ufuk Tütün Hakkı Zafer İşcan Cemal Levent Birincioğlu

Abstract

ÖZET
Amaç: İskemik kalp hastalığına bağlı gelişen mitral yetmezlik, halen operatif mortalitesi yüksek seyirli bir
hastalıktır. Cerrahi prosedür olarak halen bir fikir birliği sağlanmamıştır. Bu çalışmada İskemik Mitral Yetmezlikte
(İMY), mitral kapak replasmanı (MVR) ve tamir sonuçlarının karşılaştırılarak, birbirlerine üstünlüklerini
ortaya koymak amaçlanmıştır.
Materyal ve Metod: 2007 ve 2011 yılları arasında Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde,
İMY nedeniyle opere edilen 36 hasta incelenmiştir. Hastaların (38.9%) kadın, 22’si (61.1%) erkekti. 20 hastaya
MVR, 16 hastaya mitral rekonstrüksiyon yapıldı. Her iki grupta bütün vakalarda koroner bypass mevcuttu.
Hastalarda preoperatif risk faktörleri, mitral yetersizliğin derecesi, sol ventrikül ejeksiyon fraksiyonları, prepostoperatif
fonksiyonel klasifikasyonları, aort kros klemp ve kardiyopulmoner bypass süreleri, yoğun bakım
ve hastane kalış süreleri belirlendi.
Bulgular: MVR yapılan grupta preoperatif diyastolik çap ve kontrol diyastolik çap arasında anlamlı olarak fark
saptanmıştır (p=0.016). Bu grupta diyastolik çaptaki düzelme tamir grubuna göre istatistiksel olarak daha
iyi çıkmıştır. Ayrıca preoperatif fonksiyonel kapasite (FK) ve kontrol FK arasında, düzelme yönünde anlamlı
fark bulunmuştur (p=0.008). Erken dönem mortalite görülen hastalar incelendiğinde MVR yapılan grupta
6 hasta, tamir grubunda 5 hasta exitus oldu. Mortalite görülen 11 hasta ile sağ kalan hastalar preoperatif
ejeksiyon fraksiyonu (EF) yönünden karşılaştırıldığında anlamlı bir fark bulunmamıştır (p=0.986)
Sonuç: İMY‘de öncelikle mitral tamir önerilse de, son zamanlarda bazı çalışmalarda da önerildiği gibi, MVR
yapılması mitral yetmezliğin tam giderilmesini sağlayıp, reoperasyon
riskini azaltmaktadır.
Anahtar Sözcükler; İskemik Mitral Yetmezlik, Koroner Arter ByPass, Mitral Kapak Replasmanı, Mitral Tamir
ABSTRACT
Objective: Mitral insufficiency due to ischemic heart disease is still a disease with high operative mortality.
There is still no consensus as surgical procedure. In this study, it is aimed to reveal the superiority of ischemic
mitral insufficiency (IMI), mitral valve replacement (MVR) and repair results.
Materials and Methods: 2007 and High-Turkey Training and Research Hospital between the years of 2011,
36 patients were operated for IMI was examined. The patients (38.9%) were female and 22 (61.1%) were
male. MVR was performed in 20 patients and mitral reconstruction was performed in 16 patients. There was
coronary bypass in all cases. Preoperative risk factors, degree of mitral regurgitation, left ventricular ejection
fractions, pre-postoperative functional classifications, aortic cross clamp and cardiopulmonary bypass duration,
intensive care and hospital stay were determined.
Results: There was a significant difference between preoperative diastolic diameter and control diastolic
diameter in the MVR group (p = 0.016). In this group diastolic diametric improvement was statistically better
than the repair group. Furthermore, there was a significant difference between the preoperative functional
capacity (FC) and control FC in terms of improvement (p = 0.008). When the patients with early mortality
were examined, 6 patients in the MVR group and 5 patients in the repair group died. There was no significant
difference between 11 patients with mortality and the survivors in terms of preoperative ejection
fraction (EF) (p = 0.986).
Conclusion: Although mitral repair is recommended in IMI, as recently suggested in some studies, MVR
provides complete removal of mitral insufficiency and reduces the risk of reoperation.
Keywords: Ischemic Mitral Insufficiency, Coronary Artery By-Pass Grafting, Mitral Valve Replacement, Mitral
Repair

Keywords

İSKEMİK MİTRAL YETMEZLİKTE KAPAK REPLASMANI VE TAMİR SONUÇLARININ KARŞILAŞTIRILMASI Comparison of the Surgical Results Between Valve Replacement and Repair in the Treatment of Mitral Insufficieny

References

• 1. Kay JH, Zubiate P, Mendez MA, Vanstrom N, YokoyamaT, Gharavi MA. Surgical treatment of mitral insufficiency secondary to coronary artery disease. J ThoracCardiovascSurg 1980; 79:12-18 2. David TE. Techniques and results of mitral valve repair for ischemic mitral regurgitation. J CardiacSurg 1994;9:274 3. Orszulak TA, Schaff HV, Danielson GK, Piehler JM, Pluth JR, Frye RL, Mcgoon DC. Mitral regurgation due to ruptured chordae tendinea. J ThoracCardiovascSurg 1985; 89:491-498 4. Goor DA, Mohr RM, Lavee J, Serraf A, Smolinsky A. Preservation of the posterior leaflet during mechanical valve replacement for ischemic mitral regurgation and complete myocardial revascularization. J ThoracCardiovascSurg 1988;96:253-260. 5. Rankin JS, Hickey MS, Smith R, Muhlbeier L, Reves JG, Pryor DB, Wechsler AS. Ischemic mitral regurgitation. Circulation 1989;79:116-121 6. Gillinov AM, Wierup PN, Blackstone EH,, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J ThoracCardiovascSurg 2001;122:1125-41 7. Grossi EA, Goldberg JD, LaPietra A, et al. Ischemic mitral valve reconstruction and replacement: Comparison of long term survival and complications. J ThoracCardiovascSurg 2001;122:1107-24 8. Conally MW, Gelbfish JS, Jacobowitz IJ, Rose DM, Mendelson A, Cappabianca PM, Acinapura AJ, Cunningham JN. Surgicalresultsfor mitral regurgitation from coronary artery disease. J ThoracCardiovascSurg 1986;91:379-388 9. McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2004;128:916-24. 10. Magne J, Sénéchal M, Dumesnil JG, Pibarot P. Ischemic mitral regurgitation: a complex multifaceted disease. Cardiology 2009;112:244-59.