Repair of Complex Mitral Valve Pathologies: Is It Worth to Cope With?

Year 2018, Volume: 21 Issue: 1, 32 - 38, 01.04.2018

Salih Salihi H. Tarık Kızıltan Aşkın Ali Korkmaz Mustafa Güden

Abstract

Introduction:
Mitral
valve (MV) repair is preferred over replacement for its benefits of
preservation of ventricular function, lower operative mortality, superior
long-term survival, and avoidance of anticoagulation. In this study, we aimed
to review the repair techniques of complex MV pathologies and their outcomes.

Patients
and Methods: We retrospectively analyzed 56 patients (mean age 41.8 ±
16.5 years; 33 males) who underwent repair of complex MV pathologies. 44
patients had pure mitral regurgitation (MR), and 12 (21.4%) had mixed mitral
disease (mitral stenosis (MS) + MR). Preoperative and operative
characteristics, postoperative MR severity, operative mortality, and midterm
survival were examined for each patient.

Results: There was
only one early death (30-day mortality: 1.8%) due to postoperative low cardiac
output syndrome. The procedures were successful in all patients who underwent
MV repair. Transthoracic echocardiography examinations revealed no/trivial MR
in 74.6% and mild MR in 21.8% of patients at discharge. Late follow-up was
obtained in 55 patients. The mean follow-up period of patients was 47.9 ± 23.1
months. Mortality developed in one (1.8%) patient with Marfan syndrome who had
acute aortic dissection three years after MV surgery. During follow-up visits,
mitral repair procedures were successful in 49 (90.7%) patients. Four (7.4%)
patients presented with moderate MR. Only one (1.9%) patient needed reoperation
because of severe MR.

Conclusion: This study showed that
repair of complex MV pathologies provides excellent surgical outcomes. Repair
of complex MV pathologies is safe and highly effective, but operations require
considerable surgical experience.

Keywords

Mitral valve repair, mitral regurgitation, mitral stenosis

Kompleks Mitral Kapak Patolojilerin Onarımı; Uğraşmaya Değer mi?

Abstract

Giriş: Ventrikül fonksiyonun korunması, daha az cerrahi mortaliteye sahip olması,
üstün uzun dönem survey ve antikoagülan kullanımının önlenmesi gibi
üstünlükleri nedeniyle mitral kapak onarımı replasmana daha çok tercih
edilmektedir. Bu çalışmanın amacı, kompleks mitral kapak patolojilerin onarım
teknikleri ve sonuçları sunmaktır.

Hastalar ve
Yöntem: Retrospektif olarak kompleks mitral kapak patolojilerin
onarımı geçiren 56 hasta incelendi (ortalama yaş 41.8 ± 16.5 yıl; 33 erkek).
Kırk dört hastada saf mitral yetmezliği varken, 12 (%21.4) hastada miks mitral
kapak hastalığı (mitral darlığı + mitral yetmezliği) vardı. Preoperatif ve
operatif özellikleri, postoperatif mitral yetmezliği derecesi, cerrahi
mortalite ve orta dönem sonuçları her hasta için araştırıldı.

Bulgular: Postoperatif düşük kardiyak debi sendromuna bağlı bir hastada erken
mortalite (30 gün mortalite: %1.8) görüldü. Mitral kapak onarımı ameliyatı olan
bütün hastalarda mitral onarım prosedürleri başarılı olmuştur. Hastalar taburcu
olduğunda yapılan ekokardiyografik değerlendirmede %74.6’sında hiç/eser
yetersizlik ve %21.8’inde hafif yetersizlik saptandı. 55 hastada geç dönem
takibi yapıldı. Hastalarımızın ortalama takip süresi 47.9 ± 23.1 aydı. Geç
mortalite mitral kapak onarımından 3 yıl sonra akut aort diseksiyonu nedeniyle
ameliyata alınan marfan sendromlu bir hastada gözlendi. Takipler sırasında
yapılan ekokardiyografik değerlendirmede hastaların %90.7 (49 hasta)’sinde  hiç ya da hafif yetersizlik gözlendi. Orta
yetersizlik gözlenen 4 (%7.4) hastada tıbbi tedavi uygulandı. İleri yetersizlik
gözlenen 1 (%1.9) hastada reoperasyon uygulandı.

Sonuç: Çalışmamız kompleks mitral
kapak patolojilerin onarımının sonuçları mükemmel olduğunu gösterdi. Kompleks
mitral kapak patolojilerin onarım teknikleri güvenli ve sonuçları son derece
etkindir, fakat ameliyatlarda yeterli cerrahi tecrübe gereklidir.

Keywords

Mitral kapak onarımı, mitral yetmezliği, mitral darlığı

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