Sol Ventrikül Kitle İndeksinin Dikişsiz Biyoprotez Kapak ile Aort Kapak Replasmanı Sonrası Erken Dönem Sonuçlara Etkisi; İki On Yılın Karşılaştırılması

Yıl 2019, Cilt: 22 Sayı: 2, 112 - 119, 15.08.2019

Arzu Antal Burçin Çayhan Karademir Mehmet Dedemoğlu Ekin Can Çelik Mehmet Altuğ Tuncer

Öz

Giriş: Çalışmanın
amacı artmış sol ventrikül kitle indeksinin, aort darlığı nedeniyle dikişsiz
biyoprotez kapak ile aort kapak replasmanı sonrası erken dönem sonuçlara
etkisinin araştırılmasıdır.

 

Hastalar ve Yöntem:
Aort darlığı nedeniyle dikişsiz biyoprotez kapak ile aort kapak replasmanı
uygulanan 60 yüksek riskli hastanın operasyon sonrası erken dönem sonuçları
retrospektif olarak analiz edilmiştir. Hastalar sol ventrikül kitle indeks
değerlerine göre iki gruba ayrılmıştır. Sol ventrikül kitle indeksi Devereux
formula ile hesaplanıp, vücut yüzey alanı ile indekslenmiştir. Erkek hastalar
için > 134 g/m2 , kadın hastalar için > 100 g/m2 yüksek olarak
tanımlanmıştır. Cerrahi sonrası erken dönem sonuçlar iki hasta grubunda
karşılaştırmalı olarak değerlendirilmiştir.

 

Bulgular: Operasyon
öncesi hasta özellikleri gruplar arasında benzer bulunmuştur. Erken mortalite
%8.3’tür. Operasyon sonrası erken dönem mortalite ve morbidite açısından
gruplar arasında anlamlı fark tespit edilmemiştir. Sol ventrikül kitle indeksi
birinci grupta 114.7 ± 13.7 g/m2 ’den 109 ± 32.2 g/m2 ’ye (p= 0.60), yüksek
kitle indeksi olan ikinci grup hastalarında 192.5 ± 31.9 g/m2 bazal değerinden
117.9 ± 25.2 g/m2 ’ye gerilemiştir (p< 0.001).

 

Sonuç: İzole aort
darlığında operasyon öncesi artmış sol ventrikül kitle indeksinin, dikişsiz
biyoprotez kapak ile aort kapak replasmanı sonrası erken dönem morbidite ve
mortalite üzerine olumsuz etkisi tespit edilmemiştir. Ciddi sol ventrikül
hipertrofisi olan yüksek riskli bu hasta grubunda altı aylık takipte sol
ventrikül kitle indeksinde anlamlı azalma görülmesi cesaret verici olmakla
birlikte uzun dönem takip gerektirmektedir

Anahtar Kelimeler

Aort kapak stenozu, sol ventrikül hipertrofisi, kalp kapak protezleri

Impact of Left Ventricular Mass Index on Early Outcomes After Aortic Valve Replacement with Sutureless Bioprosthetic Valve: A Comparison of Two Decades

Öz

Introduction: The
objective of the present study was to elucidate whether high left ventricular
mass index (LVMI) affects early outcomes after sutureless bioprosthetic aortic
valve replacement (AVR) in aortic stenosis (AS).

 

Patients and Methods:
Postoperative early outcomes of 60 high-risk patients with aortic valve stenosis
after replacement with sutureless bioprosthetic valve were retrospectively
analyzed. Patients were grouped into two depending on LVMI. Left ventricular
(LV) mass was calculated using the Devereux formula and indexed to the body
surface area. High LVMI was defined as LVMI > 134 g/m2 for males and LVMI
> 100 g/m2 for females. Early outcomes of surgery were compared between the
normal and high LVMI patient groups.

 

Results: Preoperative
patient characteristics were similar between the groups. Early mortality was
8.3%. There was no statistically significant difference between the groups with
respect to postoperative early complication rates and mortality. LVMI decreased
from 114.7 ± 13.7 g/m2 at baseline to 109 ± 32.2 g/m2 at follow-up in group I
(p= 0.60) and from 192.5 ± 31.9 g/m2 at baseline to 117.9 ± 25.2 g/m2 in group
II (p< 0.001).

 

Conclusion: The
impact of high LVMI on morbidity and mortality after AVR with sutureless
bioprosthetic valve was not deleterious in patients with isolated AS.
Significant reduction in LVMI at 6 months is encouraging for these high-risk
patients with severe LV hypertrophy; however, long-term follow-up is required.

Anahtar Kelimeler

Aortic stenosis, left ventricular hypertrophy, heart valve prosthesis

Kaynakça

• 1. Kupari M, Turto H, Lommi J. Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure? Eur Hear J 2005;26:1790-6.
• 2. Thomson HL, O’Brien MF, Almeida AA, Tesar PJ, Davison MB, Burslefttov DJ. Hemodynamics and left ventricular mass regression: a comprasion of the stentless, stented and mechanical aorticvalve replacement. Eur J Cardiothorac Surg 1998;13:572-5.
• 3. Villa E, Troise G, Cirillo M, Brunelli F, Tomba MD, Mhagna Z, et al. Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An overview. Cardiovasc Ultrasound 2006;4:25.
• 4. Phan K, Tsai YC, Niranjan N, Bouchard D, Carrel TP, Dapunt OE, et al. Sutureless aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg 2015;4:100-11.
• 5. Shrestha M, Fischlein T, Meurisc B, Flamengc W, Carreld T, Madonnae F, et al. European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes upto 5 years in over 700 patient. Eur J Cardiothorac Surg 2016;49:234-41.
• 6. Santarpino G, Pfeiffer S, Pollari F, Concistrè G, Vogt F, Fischlein T. Left ventricular mass regression after sutureless implantation of the Perceval S aortic valve bioprosthesis: preliminary results. Interactive Cardio Vasc and Thorac Surg 2014;18:38-42.
• 7. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977;55:613-8.
• 8. Levy D, Savage DD, Garrison RJ, Anderson KM, Kannel WB, Castelli WP. Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987;59:956-60.
• 9. Foppa M, Duncan BB, Rohde LEP. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovascular Ultrasound 2005;3:17.
• 10. Gerdts E, Rossebo AB, Pedersen TR, Cioffi G, Lonnebakken MT, Cramariuc D, et al. Relation of left ventricular mass to prognosis in initially asymptomatic mild to moderate aortic valve stenosis. Circ Cardiovasc Imaging 2015;8:e003644.
• 11. Orsinelli DA, Aurigemma GP, Battista S, Krendel S, Gaasch WH. Left ventricular hypertrophy and mortality after aortic valve replacement for aortic stenosis. JACC 1993;22:1679-83.
• 12. Duncan AI, Lowe BS, Garcia MJ, Xu M, Gillinov AM, Mihaljevic T, et al. Influence of concentric left ventricular remodeling on early mortality after aortic valve replacement. Ann Thorac Surg 2008;85:2030-9.
• 13. Minamino-Muta E, Kato T, Morimoto T, Taniguchi T, Inoko M, Haruna T, et al. Impact of the left ventricular mass index on the outcomes of severe aortic stenosis. Heart 2017;103:1992-9.
• 14. Mehta RH, Bruckman D, Das S, Tsai T, Russman P, Karavşte D, et al. Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgery. J Thorac Cardiovasc Surg 2001;122:919-28.
• 15. Fuster RG, Argudo JA, Albarova OG, Sos FH, Lopez SC, Sorli MJ, et al. Left ventricular mass index in aortic valve surgery: a new index for early valve replacement? Eur Cardiothorac Surg 2003;23:696-702.
• 16. Folliguet TA, Laborde F, Zannis K, Ghorayeb G, Haverich A, Shrestha M. Sutureless Perceval aortic valve replacement: results of two European centers. Ann Thorac Surg 2012;93:1483-8.
• 17. Borger MA, Dohmen P, Misfeld M, Mohr FW. Current trends in aortic valve replacement: development of the rapid deployment Edwards Intuity valve system. Exp Rev Med Devices 2013;10:461-70.
• 18. Kocher AA, Laufer G, Haverich A, Shrestka M, Walther T, Misfeld M, et al. One-year outcomes of the Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the Edward Intuity Valve System. J Thorac Cardiovasc Surg 2013;145:110-5.
• 19. Concistre G, Chiaramonti F, Santarpino G, Pfeiffer S, Marchi F, Vogt F, et al. Left ventricular mass regression after two alternative sutureless aortic bioprostheses. Innovations 2015;10;114-9.
• 20. Antal Dönmez A. Aort darlığı nedeniyle uygulanan aort kapak replasmanında sol ventrikül kitle indeksinin erken morbidite ve mortalite üzerine etkisi. T.C. Sağlık Bakanlığı Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye, 2003.
• 21. Concistre G, Miceli A, Marchi F, Chiaramonti F, Glauber M, Solinas M. Regression of left ventricular mass after implantation of the sutureless 3f Enable aortic bioprosthesis. Tex Heart Inst J 2015;42:117-23.
• 22. Lund O, Emmertsen K, Dorup I, Jensen FT, Flo C. Regression of left ventricular hypertrophy during 10 years after valve replacement for aortic stenosis is related to the preoperative risk profile. Eur Heart J 2003;24:1437-46.
• 23. Tasca G, Brunelli F, Cirillo M, Tomba MD, Mhagna Z, Troise G, et al. Impact of the improvement of valve area achieved with aortic valve replacement on regression of left ventricular hypertrophy in patients with pure aortic stenosis. Ann THorac Surg 2005:79;1291-6.
• 24. Rubens FD, Gee YY, Ngu JMC, Chen L, Burwash IG. Effect of pericardial valve choice on outcomes and left ventricular mass regression in patients with left ventricular hypertrophy. J Thorac Cardiovasc Surg 2016:152;1291-8.
• 25. Del Rizzo DF, Abdoh A, Cartier P, Doty D, Westaby S. Factors affecting left ventricular mass regression after aortic valve replacement with stentless valves. Semin Thorac Cardiovasc Surg 1999;11(4 Suppl 1):114-20.
• 26. Lim E, Ali A, Theodorou P, Sousa I, Ashrafian H, Chamageorgakis T, et al. Longitudunal study of the profile and predictors of left ventricular mass regression after stentless aortic valve replacement. Ann Thorac Surg 2008;85:2026-9.
• 27. Moscarelli M, Fattouch K, Speziale G, Nasso G, Santarpino G, Gaudino M, et al. A meta-analysis of the performance of small tissue versus mechanical aortic valve prostheses. Eur J Cardiothorac Surg 2019.
• 28. Belluschi I, Moriggia S, Giacomini A, Del Forno B, Di Sanzo S, Blasio A, et al. Can Perseval sutureless valve reduce rate of patient prosthesis mismatch? Eur J Cardiothorac Surg 2017:51;1093-9.
• 29. Haverich A, Wahlers TC, Borger MA, Shrestha M, Kocher AA, Walther T, et al. Three-year hemodynamic performance, left ventricular mass regression, and prosthetic-patient mismatch after rapid deployment aortic valve replacement in 287 patients. J thorac Cardiovasc Surg 2014;148:2854-61.