Asendan Aort Replasmanıyla ile Birlikte veya İzole Aort Kapak İmplantasyonu İçin Parsiyel Üst Sternotomi

Abstract

Giriş: Kalp cerrahisi tekniklerindeki ilerlemelerle birlikte, minimal invaziv yaklaşımlar cerrahlar tarafından gittikçe daha çok tercih edilmektedir. Daha küçük bir insizyon yapılması belirli cerrahi prosedürler sırasında cerrahın hareketlerine engel olmadan yeterli görünürlük sağlayabilmektedir. Dahası sınırlı bir insizyon daha iyi kozmetik sonuçlar ve daha iyi yaşam kalitesi sunmaktadır. Bu çalışma izole ve kombine aort kapak operasyonları için sınırlı cilt insizyonuyla parsiyel üst sternotomi kullanımına dair deneyimlerimizi sunmaktadır.

Hastalar ve Yöntem: Ocak 2013-Aralık 2014 tarihleri arasında toplam 34 hastaya parsiyel J-şeklinde üst sternotomi yoluyla aort kapak cerrahisi uygulandı. On altı hastada (%47.0) izole aort kapak replasmanı, 18 hastada (%53) modifiye Bentall prosedürü gerçekleştirildi. Tanımlayıcı veriler olarak demografik ve klinik sonuç parametreleri bildirildi.

Bulgular: Ortalama yaş 54 ± 14 yıldı (aralık 19 ila 82 yaş) ve hastaların 11  (%32)’i kadındı. Ortalama ameliyat süresi 6.8 ± 1.8 saatti (aralık 4 ila 10 saat). Erken mortalite bir hastada meydana geldi. İki hasta yara yeri infeksiyonu nedeniyle yara bakımı için rehospitalize edildi. 

Sonuç: Aort kapak cerrahisi için parsiyel üst ministernotomi kullanımına dair ilk sonuçlarımız cesaret vericidir. Söz konusu teknik aort kapak cerrahisi sırasında, proksimal asendan aorta dahil yeterli ulaşılabilirlik sağlamaktadır. Tekniğin güvenilirliğinin ve etkililiğinin sınanması için daha ileri düzeyde çalışmalara ihtiyaç vardır. 

Keywords

• Minimal invaziv aort kapak cerrahisi,ministernotomi,minimal invaziv kalp cerrahisi,aort kapak replasmanı

Partial Upper Sternotomy for Concomitant with Ascendant Aorta Replacement or Isolated Aortic Valve Implantation

Abstract

Introduction: Less-invasive procedures have gained more widespread adoption among cardiovascular surgeons as a result of continuous advances in the field of cardiac surgical techniques. It has now become clear that even smaller incisions may provide adequate exposure in certain cardiac surgical procedures without compromising the surgeon’s view of the surgical field. Furthermore, a limited incision offers the advantage of cosmetic outcomes, hence an improved quality-of-life after the operation. Herein, we report our experience regarding the use of partial upper sternotomy with limited skin incision for isolated or combined aortic valve operations.

Patients and Methods: A total of 34 patients underwent aortic valve surgery via partial J-shaped upper sternotomy in two separate centers between January 2013 and December 2014. Sixteen patients (47%) underwent an isolated aortic valve replacement, while 18 patients (53%) underwent a modified Bentall procedure. Descriptive data included demographic and clinical outcome parameters.

Results: Mean age was 54 ± 14 years (range: 19 to 82 years) and there were 11 females (32%). The average duration of surgery was 6.8 ± 1.8 hours, ranging from 4 to 10 hours. Early mortality occurred in 1 patient. Two patients had wound infection and they were re-hospitalized for wound care.

Conclusion: Our preliminary result regarding the use of partial upper ministernotomy is encouraging. The technique allows adequate exposure during aortic valve surgery, even in procedures involving the proximal ascending aorta. Further studies are warranted to test the safety and efficacy of this approach.

Keywords

• Minimally invasive aortic valve surgery,ministernotomy,minimally invasive cardiac surgery,aortic valve replacement

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