genel tıp derg Genel Tıp Dergisi 2602-3741 Selcuk University 10.54005/geneltip.1217843 Clinical Sciences Klinik Tıp Bilimleri Biliflet Prolapsusu Olan Hastalarda Mitral Kapak Tamirinin Postoperatif Sonuçları Postoperative Outcomes of Mitral Valve Repair in Patients with Bileaflet Prolapse https://orcid.org/0000-0002-7132-8586 Günertem Eren Ankara Medicalpark Hastanesi https://orcid.org/0000-0002-4675-3273 Çiçek Ömer Faruk https://orcid.org/0000-0002-5526-5298 Mola Serkan https://orcid.org/0000-0002-1249-4373 Kadirogulları Ersin https://orcid.org/0000-0001-7034-9548 Erkengel Halil İbrahim https://orcid.org/0000-0002-8782-7603 Diken Adem İlkay https://orcid.org/0000-0002-0752-6553 Yalçınkaya Adnan https://orcid.org/0000-0003-2599-6521 Yaşar Emre https://orcid.org/0000-0003-2075-0143 Altintas Garip https://orcid.org/0000-0003-1867-5842 Ulaş Mahmut https://orcid.org/0000-0002-0639-4341 Lafçı Gökhan 04 30 2023 33 2 154 161 12 14 2022 04 10 2023 Copyright © 1990, Genel Tıp Dergisi 1990 Genel Tıp Dergisi

GirişGünümüzde 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.MetodlarBu 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.BulgularOrtalama 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.Sonuçİyi 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.

BackgroundToday, 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 techniquesMethods 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. ResultsMean 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.

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