Sağ Ventrikül Çıkış Yolu Darlıklarının Tamirinde Homogreft ve Contegra Greft Kullanılan Hastaların Sağ Kalımının Karşılaştırılması

Abstract

Giriş ve Amaç: Homogreftler veya ksenogreftler sağ ventrikül çıkış yolu (RVOT) darlıklarının tedavisinde günümüzde en sık kullanılan materyallerdir. Çalışmanın amacı RVOT tamirlerinde homogreft ve Contegra® Greft (ksenogreft) kullanılan hastaların mortalite oranlarını belirlemek ve sağ kalımlarını karşılaştırmaktır. Çalışmanın ikincil amacı ise mortalite için risk faktörlerinin belirlenmesidir. Gereç ve Yöntemler: Çalışmaya üçüncü basamak sağlık kuruluşumuzda son yedi yılda RVOT darlığı nedeniyle homogreft veya Contegra® Greft kullanılarak RVOT rekonstrüksüyonu uygulanan hastalar dahil edilmiştir. Toplam 71 hastanın; 18’ine homogreft (%25,4) ve 53’üne (%74,6) ise Contegra® Greft ile RVOT rekonstrüksüyonu uygulanmıştır. Çalışma için yerel etik kurul izni alınmıştır. Bulgular: RVOT darlığının en sık etiyolojik sebebi Fallot Tetralojisiydi. Contegra® Greft grubunun yaş ortalaması ve kullanılan greft çapları (t test, p<0,01) daha küçüktü. Grupların kross-klemp ve kardiyopulmoner bypass süreleri, hastanede yatış süreleri benzerdi. Grupların total mortalite oranları arasında farklılık yoktu (Fisher Exact Test, p=0,17). Contegra® Greft grubu için tahmin edilen ortalama sağ kalım süresi 5,6 yılken, homogreft grubunda yaklaşık 4 yıldır. Contegra® Greft grubunda 1 yıllık sağ kalım %88 iken 5 yılda oran %83’e düşmektedir (Kaplan-Meier metodu). Multivariate Cox regresyon analizinde tanı, redo operasyonlar, cinsiyet, vücut yüzey alanı mortalite için risk oluşturmazken, 1 yaş altında olmak mortalite için bağımsız bir risk faktörüydü. Sonuç: RVOT darlıklarının tamirinde Contegra® Greftler, homogreftlerin iyi bir alternatifidir. Erken ve orta dönemdeki benzer fonksiyonel kapasite ve sağ kalım oranları nedeniyle hastaya uygun homogrefte ulaşılamadığında Contegra® Greftler RVOT rekonstrüksüyonunda güvenle kullanılabilir.

Keywords

• Contegra® heterogreft
• Homogreft
• Ksenogreft
• Sağ ventrikül çıkış yolu
• Sağ kalım

Comparison of the Survival of Patients who Underwent Right Ventricular Outflow Tract Repair with Homografts Versus Contegra Grafts

Abstract

Objective: Homografts or xenografts are the most commonly used materials in the treatment of right ventricular outflow tract (RVOT) stenosis. The aim of the study is to determine the mortality rates and compare the survival rates of patients who underwent RVOT repair by using homograft and Contegra® Graft (xenograft). The secondary endpoint of the study was to determine the risk factors for mortality. Materials and Methods: We included 71 patients who are operated in last seven years in our tertiary healthcare service for RVOT reconstructions by using homograft or Contegra® Graft. Homograft was applied 18 of them (24.5%) and Contegra® Graft was applied 53 of them (74.6%). Local ethical committee approved the study. Results: Tetralogy of Fallot was the most common etiological cause of RVOT stenosis. The average age and the graft diameters that used were in smaller size (t test, p <0.0001) in Contegra® Graft group. Cross-clamp and cardiopulmonary bypass times and duration of the hospitalization of the groups were similar. There was no difference between the total mortality rates of the groups (Fisher Exact Test, p = 0.179). The estimated median survival for the Contegra® Graft group is 5.6 years, while in the homograft group it is about 4 years. Survival rates in the Contegra® Graft group, was 88% at 1 year, and the rate decreased to 83% at 5 years (Kaplan-Meier method). In Multivariate Cox regression analysis, the diagnosis, redo operations, gender, body surface area did not pose a risk for mortality, while being under 1 year of age was an independent risk factor for mortality. Conclusion: Contegra® Graft is a good alternative to homograft for the repair of RVOT obstructions. Because of similar functional capacity and survival rates of the patients in early and mid-term, Contegra® Grafts can be safely used for RVOT reconstruction when a homograft suitable to the patient is not available.

Keywords

• Contegra® heterograft
• Homograft
• Right ventricular outflow tract (RVOT)
• Survival
• Xenograft

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