Comparison of Early Results of Mechanical Valve and Sutureless Biological Valve Replacement in Patients with Symptomatic Aortic Stenosis

Abstract

Aim: In this study, it is aimed to compare the early results of sutureless bioprosthetic aortic valve and mechanical valve replacement in high-risk patients with severe symptomatic aortic stenosis.

Material and Methods: Between January 2015 and September 2018, 34 (18 males, 16 females) patients who underwent sutureless bioprosthetic aortic valve replacement (Edwards, Intuity) and 50 (29 males, 21 females) mechanical aortic valve replacement (Medtronic, ATS) were included in the study. It is aimed to compare the demographic data and postoperative 1st month data of patients.

Results: In patients with mechanical valve insertion, ejection fraction (EF) was 60 (38-69), New York Heart Association (NYHA) classification was 3 (2-4), EuroSCORE was 3 (0-7) and mean gradient was 56 (40-75) mmHg, while in patients with sutureless valve EF was determined as 52 (33-68), NYHA as 4 (2-4), EuroSCORE as 5 (0-7) and mean gradient as 60 (40-95) mmHg. In patients who underwent mechanical aortic valve replacement, 9 patients underwent coronary bypass, 7 patients underwent mitral valve replacement and 2 patients underwent tricuspid ring annuloplasty, simultaneously. In patients who underwent sutureless valve replacement, 8 patients underwent coronary bypass, 1 patient underwent mitral valve replacement and 1 patient underwent mitral repair. In both groups, a patient died within the first 30 days postoperatively.

Conclusion: Advanced age and the presence of comorbidities increase the mortality and morbidity in operations due to aortic stenosis. Sutureless aortic valve replacement can be safely used in high-risk patients with low mortality and morbidity, excellent hemodynamics and short implantation time.

Keywords

• Aortic stenosis,sutureless biological valve,mechanic valve,mortality

Semptomatik Aort Darlığı Bulunan Olgularda Mekanik Kapak ve Dikişsiz Biyolojik Kapak Replasmanının Erken Dönem Sonuçlarının Karşılaştırılması

Abstract

Amaç: Bu çalışmada ileri semptomatik aort darlığı bulunan yüksek riskli hastalarda dikişsiz biyoprotez aort kapak ve mekanik kapak replasmanı erken dönem sonuçlarının karşılaştırılması amaçlandı.

Gereç ve Yöntemler: Ocak 2015 ve Eylül 2018 tarihleri arasında 34 (18 Erkek, 16 Kadın) dikişsiz biyoprotez aort kapak replasmanı (Edwards, Intuity) ve 50 (29 Erkek, 21 Kadın) mekanik aort kapak replasmanı (Medtronic, ATS) yapılan hasta çalışmaya alındı. Hastaların demografik verileri ve postoperatif 1. ay verilerinin karşılaştırılması amaçlandı.

Bulgular: Mekanik kapak takılan hastalarda ejeksiyon fraksiyonu (EF) 60 (38-69), New York Kalp Cemiyeti (New York Heart Association, NYHA) sınıflaması 3 (2-4), EuroSCORE 3 (0-7) ve ortalama gradiyent 56 (40-75) mmHg iken, dikişsiz kapak kullanılan hastalarda ise EF 52 (33-68), NYHA 4 (2-4), EuroSCORE 5 (0-7) ve ortalama gradiyent 60 (40-95) mmHg olarak saptandı. Mekanik aort kapak replasmanı yapılan hastalarda eş zamanlı olarak 9 hastaya koroner bypass, 7 hastaya mitral kapak replasmanı ve 2 hastaya triküspid ring anüloplasti yapılmıştır. Dikişsiz kapak replasmanı yapılan grupta 8 hastaya koroner bypass, 1 hastaya mitral kapak replasmanı ve 1 hastaya mitral tamir işlemi uygulanmıştır. Her iki grupta da 1 hasta postoperatif ilk 30 gün içerisinde ex olmuştur.

Sonuç: Aort darlığına bağlı operasyonlarda ileri yaş ve komorbiditelerin varlığı mortalite ve morbiditeyi arttırmaktadır. Dikişsiz aort kapağı replasmanı yüksek riskli hastalarda düşük mortalite ve morbidite, mükemmel hemodinami ve kısa implantasyon süresi ile güvenli bir biçimde kullanılabilir.

Keywords

• Aort darlığı,dikişsiz biyolojik kapak,mekanik kapak,mortalite

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