Valve Replacement Performed on the Beating Heart with Continuous Retrograde Coronary Sinus Isothermic Blood Perfusion Combined with Coronary Bypass

Yıl 2012, Cilt: 15 Sayı: 3, 130 - 133, 01.03.2011

Orhan Saim Demirtürk Hüseyin Ali Tünel İsa Coşkun Öner Gülcan

Öz

An operation on the beating heart was planned for a 60-year-old woman who applied to our clinic with aortic stenosis, three vessel coronary artery disease and poor left ventricular function. There are reports about beating heart valve surgery perfomed alone or combined with coronary artery bypass operations using continuous retrograde coronary sinus isothermic blood perfusion in patients with poor ventricle. We performed a coronary revascularization process for three-vessel disease on the pump beating heart and aortic valve replacement under cross-clamp using continuous retrograde coronary sinus isothermic blood perfusion in the same session. She was discharged on the sixth postoperative day after an uneventful recovery. She is well and active 24 months after the operation. Valve replacement using the retrograde coronary sinus isothermic blood perfusion technique due to its protective effect on the already borderline myocardial functions in patients with poor ventricles is a useful and clinically successful method.

Anahtar Kelimeler

Aortic valve; coronary sinus; coronary artery bypass.

Çalışan Kalpte Sürekli Retrograd Koroner Sinüs İzotermik Kan Perfüzyonu ile Aort Kapak Replasmanıyla Kombine Koroner Baypas

Öz

Altmış yaşında kadın hastaya global hipokinezisi ve aort kapak darlığı nedeniyle çalışan kalpte koroner baypas ve aort kapak replasmanı planlandı. Bir süredir çeşitli yayınlarda koroner baypasla birlikte ya da tek başına aort kapak replasmanın başarılı bir şekilde çalışan kalpte yapıldığına dair makaleler yer almaktaydı. Ciddi kalsifik aort darlığı (kapak alanı 0.7 cm²'nin altında), üç damar koroner revaskülarizasyona gereksinimi olan hastaya çalışan kalpte pompa destekli koroner baypas ve aynı seansta kross-klemp altında sürekli retrograd koroner sinüs izotermik kan perfüzyonu ile aort kapak replasmanı gerçekleştirdik. Altmış yaşındaki hastanın hipertansiyonu ve diabetes mellitus komorbiditesi vardı. Geçirdiği miyokart enfarktüsü ejeksiyon fraksiyonunu azaltmıştı. Hasta yapılan üçlü baypas ve hemen sonrasında icra edilen aort kapak replasmanı ile altı gün hastane kalış süresi sonunda kendi işlerini yürütebilecek şekilde taburcu edildi. Hasta postoperatif 24. ayında sağlıklı şekilde izlenmektedir. Son zamanlarda uygulanan, morbidite ve mortaliteyi düşüren, kötü ventriküllü hastalarda akılda tutulması gereken bir tekniği hatırlatması açısından bu olguyu sunmaya değer bulduk.

Anahtar Kelimeler

Aort kapak; koroner sinüs; koroner arter baypas.

Kaynakça

• Çiçekçioğlu F, Tütün U, Babaroğlu S, Aksöyek A, Parlar AI, Mungan U, et al. Aortic valve replacement with on-pump beating heart technique. J Card Surg 2007;22:221-14.
• Matsumoto Y, Watanabe G, Endo M, Sasaki H, Kasashima F, Kosugi I. Efficacy and safety of on-pump beating heart surgery for valvular disease. Ann Thorac Surg 2002;74:678-83.
• Erentürk S. Minimally invasive approach in cardiac surgery: Review. Turkiye Klinikleri J Cardiovasc Sci 2009;21:404-22.
• Ulular Ö, Eren E, Özışık K. Mid-term anjiographic results of coronary endarterectomy during off-pump coronary artery bypass grafting. Turkiye Klinikleri J Cardiovasc Sci 2010;22:213-9.
• Weman SM, Karhunen PJ, Pentillä A, Järvinen AA, Salminen US. Reperfusion injury associated with one-fourth of deaths after coronary bypass grafting. Ann Thorac Surg 2000;70:807-12.
• Battacharya K, Clugston A, Whalen H, Campanella C. Aortic valve replacement following coronary artery bypass grafting using bilateral internal mammary arteries. J Card Surg 2008;23:773-96.
• Misare BD, Krukenkamp BD, Lazer ZP, Levitsky SL. Recovery of postischemic contractile function is depressed by antegrade warm continuous blood cardioplegia. J Thorac Cardiovasc Surg 1993;105:37-44.
• Shao Z, Battacharya K, Hsich E, Park L, Walters B, Germann U, et al. c-Jun N-terminal kinases mediate reactivation of Akt and cardiomyocyte survival after hypoxic injury in vitro and in vivo. Circulation Research 2006;98:111-8.
• Salhiyyah K, Taggart D. Beating-heart valve surgery: a systematic review. Asian Cardiovasc Thorac Ann 2009;17:650-8.
• Mehlhorn U, Allen SJ, Adamus DL, Davis KL, Gogola GR, Warters RD. Cardiac surgical conditions induced by β-blocade: effect on myocardial fluid balance. Ann Thorac Surg1996;62:143-50.
• Gersak B, Sutlic Z. Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time. Heart Surg Forum 2002;5:182-6.
• Karadeniz Ü, Erdemli Ö, Yamak B, Genel N, Tütün U, Aksöyek A, et al. On-pump beating heart versus hypothermic arrested heart valve replacement surgery. J Card Surg 2008;23:107-13.
• Lillehei CW, DeWall RA, Gott VL, Varco RL. The direct vision correction of calcific aortic stenosis by means of a pumpoxygenator and retrograde coronary sinus perfusion. Dis Chest 1956;30:123-32.
• Solorzano J, Taitelbaum G, Chiu RC. Retrograde coronary sinus perfusion for myocardial protection during cardiopulmonary bypass. Ann Thorac Surg 1978;25:201-8.
• Menasché P, Kural S, Fauchet M, Lavergne A, Commin P, Bercot M, et al. Retrograde coronary sinus perfusion: a safe alternative for ensuring cardioplegic delivery in aortic surgery. Ann Thorac Surg 1982;34:647-58.
• Çiçekçioğlu F, Tütün U, Babaroğlu S, Mungan U, Parlar AL, Demirtaş E, et al. Redo valve surgery with on-pump beating heart technique. J Cardiovasc Surg (Torino) 2007;48:513-8.