Is Rheumatic Mitral Valve Disease Still Maintaining its Prevalence in Our Country? Early and Long-term Outcomes After Mitral Valve Replacement with Rheumatic Origin

Year 2018, Volume: 21 Issue: 3, 198 - 203, 02.12.2018

Mehmet Erin Tüysüz Mehmet Dedemoğlu

Abstract

Introduction: The purpose of this study was to present
early and long-term results of mitral valve replacement in the treatment of
rheumatic mitral valve disease, encountered frequently as an etiology in our
clinic.

Patients and Methods: All patients undergoing mitral valve replacement
in our clinic between July 2008 and December 2017 were retrospectively
reviewed. Patients with rheumatic mitral stenosis and/or regurgitation were
included in the study. Primary outcome of interest was early mortality rates,
long-term survival rates, and independent predictors of long-term survival.

Results: In total, 88 patients were included in the
study. Early mortality was observed in 4 (4.5%) patients. Concomitant
arrhythmia surgery was performed in 19 (21.6%) patients with preoperative
atrial fibrillation, and 11 of the 19 (12.5%) patients showed sinus rhythm
after the operation. Overall 5-year survival rate was 77.9%. When compared to
the valve pathologies, 5-year survival rates was 72.6% in patient group with
isolated mitral stenosis, 81.8% in patient group with isolated mitral
regurgitation, and 86.7%, in patient group with combined mitral stenosis and
regurgitation. There was no statistically significant difference among the
groups (p= 0.63). The existence of preoperative chronic renal failure (HR,
33.4; 95% CI, 4.1-272.3; p= 0.001) and cardiopulmonary bypass time (HR, 1.05;
95% CI, 1.02-1.08; p< 0.001) were independent predictors of long-term
survival.

Conclusion:
Rheumatic mitral valve disease remains a problem in
our country due to rural and border migration. Valve replacement is an optimal
choice and produces satisfactory results in terms of prevention of recurrence
and provision of effective valve orifice area. In addition, it is necessary to
take precautions in the presence of preoperative chronic renal failure and to
avoid prolonged cardiopulmonary bypass periods during the operation to ensure
long term survival.

Keywords

Acute rheumatic fever, atrial fibrillation, mitral valve replacement, rheumatic mitral valve disease

Romatizmal Mitral Kapak Hastalığı Ülkemizde Güncelliğini Koruyor mu? Romatizmal Kökenli Mitral Kapak Replasmanı Erken ve Uzun Dönem Sonuçlarımız

Abstract

Giriş: Bu çalışmanın
amacı kliniğimizde etyolojik olarak sık görülen romatizmal mitral kapak hastalığı
tedavisinde uyguladığımız mitral kapak replasmanı sonrası erken ve uzun dönem
sonuçları sunmaktır.

Hastalar ve Yöntem: Temmuz 2008 ila Aralık 2017 tarihleri
arasında kliniğimizde mitral kapak replasmanı yapılan tüm olgular geriye dönük
olarak incelendi. Çalışmaya, romatizmal etyoloji zemininde mitral kapak
replasmanı olan olgular dahil edildi. Primer olarak önem verilen sonuçlar,
postoperatif mortalite oranları, geç dönem sağkalım oranları ve geç dönem
mortaliteye etki eden faktörler idi.

Bulgular: Çalışmaya 88 hasta dahil edildi. Dört (%4.5) hastada ilk 30 gün içinde
mortalite görüldü. Preoperatif dönemde AF ritmi bulunan ve eş zamanlı aritmi
cerrahisi uygulanan 19 (%21.6) hastanın 11 (%12.5)’i sinüs ritmine döndü. Tüm
hastaların 5 yıllık sağkalım oranı %77.9 idi. Mitral darlık, yetmezlik ve
kombine mitral darlık ve yetmezlik patolojisine göre 5 yıllık sağkalım oranları
sırası ile %72.6, %81.8 ve %86.7 idi ve gruplar arasında istatistiksel olarak
fark yoktu (Log Rank, p= 0.63). Uzun dönem mortaliteye etki eden bağımsız
prediktörler preoperatif kronik böbrek yetmezliği varlığı (HR: 33.4, %95 CI:
4.1-272.3, p= 0.001) ve kardiyopulmoner baypas süresi (HR: 1.05, %95 CI:
1.02-1.08, p< 0.001) idi (Cox regresyon).

Sonuç:
Romatizmal mitral kapak hastalığı, kırsal ve sınır ötesinden gelen göç
nedeniyle ülkemizde halen güncelliğini korumaktadır. Rekürrensin önlenmesi,
efektif kapak orifis alanının sağlanması ve sol ventrikül çıkım yolu darlık
riskini azaltması açısından kapak replasmanı sonuçları oldukça iyi olup, daha
iyi bir seçenek olmaktadır. Ayrıca uzun dönem sağkalıma etkisi açısından
preoperatif kronik böbrek yetmezliği varlığında önlemlerin alınması ve
operasyon esnasında uzamış kardiyopulmoner baypas sürelerinden kaçınılması
gereklidir.

Keywords

Akut eklem romatizması, atriyal fibrilasyon, mitral kapak replasmanı, romatizmal mitral kapak hastalığı

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