Comparison of Perioperative Results of Sutureless and Conventional Valves in Aortic Valve Replacement Surgery

Yıl 2020, Cilt: 23 Sayı: 2, 102 - 110, 16.08.2020

Fatih Öztürk Taylan Adademir Veysel Başar Osman Türe Davut Çekmecelioğlu Mehmet Şengör Hızır Alp

Öz

Introduction: This study aimed to evaluate the early and midterm results of sutureless and conventional bioprosthetic valves in patients who underwent aortic valve replacement (AVR) due to aortic stenosis.

Patients and Methods: Patients who underwent a bioprosthetic AVR due to aortic stenosis in our institution between 2012 and 2017 were included in our study. The patients were divided into two groups on the basis of type of aortic valve prosthesis used as a sutureless valve (SU-AVR) (n= 62) and a conventional valve (CAVR) (n= 69).

Results: The EuroSCORE II in the sutureless group was found to be significantly higher as compared to the conventional group (p= 0.0121). Patients in the sutureless group underwent more mini-incisional approaches: 22 (36%) versus 4 (6%, p= 0.0002). The mean aortic cross-clamp and cardiopulmonary bypass time were significantly lower in the sutureless group as compared to the conventional one (53.8 ± 34.2 vs. 79.2 ± 36.3 minutes and 87.5 ± 40.7 vs. 117.4 ± 66.3 minutes, p< 0.0001). The mean follow-up time was 19.5 ± 15.7 months in the sutureless group and 28.0 ± 21.0 months in the conventional group. The overall survival rate of the sutureless and the conventional group was found to be 72.6% and 78.3%, respectively, (p= 0.253) when Kaplan-Meier analysis was done.

Conclusion: Although SU-AVR patients are found to have a higher preoperative risk score compared to the conventional group, yet it can be performed with comparable mortality and morbidity to C-AVR. Therefore, SUAVR is a promising alternative to C-AVR, especially in elderly and high-risk patients with comorbid diseases.

Anahtar Kelimeler

Aortic stenosis, aortic valve replacement (AVR), sutureless aortic valve

Aort Kapak Replasmanı Cerrahisinde Dikişsiz Kapaklar ile Konvansiyonel Kapakların Perioperatif Sonuçlarının Karşılaştırılması

Öz

Giriş: Bu çalışmanın amacı, aort kapak darlığı nedeniyle aort kapak replasmanı (AVR) uygulanan hastalarda dikişsiz ve konvansiyonel biyoprotez kapakların erken ve orta dönem sonuçlarını değerlendirmektir.

Hastalar ve Yöntem: Çalışmaya kliniğimizde 2012-2017 yılları arasında aort darlığı nedeniyle biyoprotez AVR uygulanan hastalar dahil edildi. Hastalar kullanılan aort kapak protez tipine göre dikişsiz kapak (n= 62) ve konvansiyonel kapak (n= 69) olarak iki gruba ayrıldı.

Bulgular: EuroSCORE II dikişsiz grupta konvansiyonel gruba göre anlamlı derecede yüksek olarak hesaplanmıştır (p= 0.0121). Mini insizyonel yaklaşım dikişsiz grupta 22 (%36) hastaya uygulanmışken, konvansiyonel grupta 4 (%6) hastaya uygulanmıştır (p= 0.0002). Ortalama aortik kros klemp ve kardiyopulmoner baypas süreleri dikişsiz grupta konvansiyonel gruba göre anlamlı olarak daha düşük bulunmuştur (53.8 ± 34.2’ye karşı 79.2 ± 36.3 dk ve 87.5 ± 40.7’ye karşı 117.4 ± 66.3 dk, p< 0.0001). Ortalama takip süresi dikişsiz grupta 19.5 ± 15.7 ay iken konvansiyonel grupta 28.0 ± 21.0 idi. Kaplan-Meire sağkalım analizi yaptığımızda tüm nedenlere bağlı ölümler hesaba katıldığında dikişsiz kapak grubunda genel sağkalım oranının %72.6, konvansiyonel kapak grubunda ise %78.3 olduğu bulunmuştur (p= 0.253).

Sonuç: Dikişsiz AVR konvansiyonel AVR’ye göre daha yüksek preoperatif risk skoruna sahip hastalarda uygulanıyor olmasına karşın, konvansiyonel AVR ile karşılaştırılabilir mortalite ve morbidite ile uygulanabilir. Bu nedenle, dikişsiz AVR özellikle komorbid hastalıkları olan yaşlı ve yüksek riskli hastalarda konvansiyonel AVR’ye umut verici bir alternatif gibi görünmektedir.

Anahtar Kelimeler

Aort darlığı, aort kapak replasmanı, dikişsiz aort kapak

Kaynakça

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