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

Yıl 2015, Cilt: 18 Sayı: 2, 80 - 83, 03.08.2015

Tanıl Özer , Mustafa Akbulut Ahmet Çağrı Aykan İlker Mataracı Eray Aksoy Mehmet Altuğ Tuncer

Öz

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. 

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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