KONJENİTAL AORT KAPAK HASTALIKLARINDA YÜKSEK EFEKTİF AÇIKLIK ALANLI PROTEZ KAPAK İLE YAPILAN AORT KAPAK REPLASMANI: ERKEN DÖNEM SONUÇLARIMIZ

Yıl 2021, , 197 - 205, 31.08.2021

Hüseyin Gemalmaz , Yıldırım Gültekin

https://doi.org/10.24938/kutfd.868750

Öz

Amaç: Bu çalışmada konjenital aort kapak hastalığı olan seçilmiş hastalarda yüksek efektif açıklık alanlı protez kapak kullanılarak yapılan aort kapak replasmanı erken dönem sonuçlarını paylaşmayı amaçladık.

Gereç ve Yöntemler: Ağustos 2019-Ağustos 2020 tarihleri arasında toplam 4 pediatrik hastaya mekanik protez kapakla aort kapak replasmanı gerçekleştirildi. Hasta bilgileri retrospektif olarak incelendi. Hastaların tamamı erkekti ve yaşları 10-14 yıl arasındaydı. Üç hastada konjenital aort stenozu vardı ve bir hastada aort stenozu nedeniyle yapılan balon valvuloplasti sonrası orta derece aort yetmezliği olduğu saptandı. Hastaların tamamına median sternotomi ile 16 mm yüksek efektif açıklık alanlı mekanik protez kapak kullanılarak aort kapak replasmanı yapıldı. Üç hastada aortik anulusun dar olması sebebiyle Manuqian tekniği ile aort kök genişletmesi uygulandı.

Bulgular: Postoperatif dönemde hiçbir hastada ritim problemi olmadı. Kanama veya tamponad nedeniyle eksplorasyon gerekmedi. Hastalar 42 (36-48) saat yoğun bakım tedavisi gördükten sonra servise alındı. Hastaneden 6.5 (6-8) günde taburcu oldular. Hiçbir hastada mortalite gelişmedi. Postoperatif erken dönemde, 1. ay ve 6. aylardaki kontrol ekokardiyografilerinde protez kapakların fonksiyonları normaldi ve patolojik bir gradient saptanmadı. Tromboembolik ve hemorajik bir komplikasyon görülmedi.

Sonuç: Bu çalışmada, konjenital aort kapak hastalığı olan seçilmiş hastalarda yüksek efektif açıklık alanlı protez kapakla yapılan aort kapak replasmanının erken dönem sonuçlarına göre iyi bir alternatif tedavi yöntemi olabileceğini düşünüyoruz. Daha çok hasta üzerinde ve daha uzun dönem takip sonuçlarını içeren çalışmalara gerek vardır.

Anahtar Kelimeler

Konjenital kalp cerrahisi, mekanik protez kapak, aort kapak replasmanı

Destekleyen Kurum

YOK

Proje Numarası

YOK

Aortic Valve Replacement with A Prosthetic Valve with A High Effective Orifice Area in Congenital Aortic Valve Diseases: Our Early Results

Öz

Objective: In this study, we aimed to share the early results of aortic valve replacement using a prosthetic valve with a high effective orifice area in selected patients with congenital aortic valve disease.
Material and Methods: Between August 2019 and August 2020, a total of 4 pediatric patients underwent aortic valve replacement with a mechanical prosthetic valve. Patient data was analyzed retrospectively. All of the patients were male and their ages were between 10 and 14 years. Three patients had congenital aortic stenosis and one patient had moderate aortic regurgitation after balloon valvuloplasty due to aortic stenosis. After median sternotomy, aortic valve replacement was performed using a 16 mm highly effective orifice area mechanical prosthetic valve in all patients. In 3 patients, aortic root enlargement was performed by Manuqian technique due to the narrow aortic annulus.
Results: No postoperative rhythm problem was observed in any patient. No surgical exploration was required due to bleeding or tamponade. The patients were taken to the service after receiving intensive care treatment for 42 (36-48) hours. They were discharged from the hospital in 6.5 (6-8) days. Mortality was not observed in any patient. The prosthetic valves were observed to be functioning normally in the postoperative early period, 1st month and 6th month control echocardiographies and no pathological gradient was detected. There were no thromboembolic or hemorrhagic complications.
Conclusion: We think that aortic valve replacement performed with a prosthetic valve with a high effective orifice area in selected patients with congenital aortic valve disease can be a good alternative treatment method according to the early results in this study. There is a need for studies with more patients and longer-term follow-up results.

Anahtar Kelimeler

Congenital heart surgery, mechanical prosthetic valve, aortic valve replacement

Proje Numarası

YOK

Kaynakça

• 1. Park MK. Pediatric Cardiology for Practitioners. 5th ed. Philadelphia. Mosby Company, 2008.
• 2. Suarez de Lezo J, Pan M, Medina A, Romero M, Melian F, Segura J et al. Immediate and follow-up results of transluminal balloon dilation for discrete subaortic stenosis. J AM Coll Cardiol. 1991;18(5):1309-15.
• 3. Ross DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet. 1967;2(7523):956-8.
• 4. Mazine A, David TE, Rao V, Hickey EJ, Christie S, Manlhiot C et al. Long-term outcomes of the Ross procedure versus mechanical aortic valve replacement: propensity-matched cohort study. Circulation. 2016;134(8):576–85.
• 5. Sievers HH, Stierle U, Charitos EI, Takkenberg JJM, Hörer J, Lange R et al. A multicenter evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry. Eur J Cardiothorac Surg. 2016;49(1):212–8.
• 6. Alsoufi B, Al-Halees Z, Manlhiot C, McCrindle BW, Al-Ahmadi M, Sallehuddin A et al. Mechanical valves versus the Ross procedure for aortic valve replacement in children: propensity-adjusted comparison of long-term outcomes. J Thorac Cardiovasc Surg. 2009:137(2);362-70.
• 7. Sharabiani MTA, Dorobantu DM, Mhani AS, Turner M, Tometzki AJP, Angelini GD et al. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol. 2016;67(24):2858-70.
• 8. Weymann A, Sabashnikov A, Popov AF. The Ross procedure: suitable for everyone? Expert Rev. Cardiovasc. Ther. 2014;12(5):549–6.
• 9. Etnel JR, Elmont LC, Ertekin E, Mokhles MM, Heuvelman HJ, Roos-Hesselink JW et al. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2016;151(1):143–52.
• 10. Dale J, Myhre E. Intravascular hemolysis in the late cause of aortic valve replacement. Relation to valve type, size and function. Am Heart J. 1978;96(1):24-30.
• 11. İlhan G, Bozok Ş, Çayır MÇ, Tüfekçi N, Küçüker ŞA. Comparison of early treatment outcomes after aortic valve replacement with sutureless, bioprosthetic, and mechanical valves: Our single-center experience with 140 patients. Cardiovasc Surg Int. 2020;7(1):20-9.
• 12. Westaby S, Van Nooten G, Sharif H, Pillai R, Caes F. Valve replacement with the ATS open pivot bileaflet prosthesis. Eur J Cardiothorac Surg. 1996;10(8):660-5.
• 13. David TE, David C, Woo A. Manlhiot C. The Ross procedure: outcomes at 20 years. J Thorac Cardiovasc Surg. 2014;147(1):85-93.
• 14. Elkins RC, Thompson DM, Lane MM, Elkins CC, Peyton MD. Ross operation: 16-year experience. J Thorac Cardiovasc Surg. 2008;136(3):623-30.
• 15. Takkenberg JJ, Kappetein AP, van Herwerden LA, Witsenburg M, Van Osch-Gevers L, Bogers AJ. Pediatric autograft aortic root replacement: a prospective follow-up study. Ann Thorac Surg. 2005;80(5):1628-33.
• 16. Mazine A, El-Hamamsy I, Ouzounian M. The Ross procedure in adults: which patients, which disease? Curr Opin Cardiol. 2017;32(6):663-71.
• 17. Mokhles MM, Rizopoulos D, Andrinopoulou ER, Bekkers JA, Roos-Hesselink JW, Lesaffre E et al. Autograft and pulmonary allograft performance in the second post-operative decade after the Ross procedure: insights from the Rotterdam Prospective Cohort Study. Eur Heart J. 2012;33(17):2213-24.
• 18. Elkins RC, Knott- Craig CJ, Ward KE, Lane MM: The Ross operation in children: 10-year experience. Ann Thorac Surg. 1998;65(2):496-502.
• 19. Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW. Surgery for aortic stenosis in children: a 40-year experience. Ann Thorac Surg. 2003;76(5):1398-411.
• 20. Elkins RC, Lane MM, McCue C. Ross operation in children: late results. J Heart Valve Dis. 2001;10(6):736-41.
• 21. Fullerton DA. Aortic valve replasman. In: Kaiser LR, Kron IL, Spray TL, eds. Mastery of Cardiothoracic Surgery. 2nd ed. Philadelphia. Lippincott Williams&Wilkins, 2007:410-23.
• 22. Emery RW, Van Nooten GJ, Tesar PJ. For the Investigators for the ATS Clinical Open Pivot Heart Valve Food and Drug Administration Study the initial experience with the ATS medical mechanical cardiac valve prosthesis. Ann Thorac Surg. 2003;75(2):444-52.
• 23. Sezai A, Hata M, Niino T, Yoshitake I, Kasamaki Y, Hirayama A et al. Fifteen years of experience with ATS mechanical heart valve prostheses. J Thorac Cardiovasc Surg. 2010;139(6):1494-1500.
• 24. Van Nooten GJ, Caes F, Francois K, Bove T, Vandenplas G, De Pauw M et al. Fifteen years single-center experience with the ATS bileaflet valve. J Heart Valve Dis. 2009;18(4):444-52.
• 25. Akhtar RP, Abid AR, Zafar H, Cheema MA, Khan JS. Anticoagulation in pregnancy with mechanical heart valves: 10-year experience. Asian Cardiovasc Thorac Ann. 2007;15(6):497-501.
• 26. Sillesen M, Hjortdal V, Vejlstrup N, Sørensen K. Pregnancy with prosthetic heart valves - 30 years’ nationwide experience in Denmark. Eur J Cardiothorac Surg. 2011;40(2):448-54.
• 27. Shiono M, Sezai Y, Sezai A, Omoto R, Kyo S, Hatanaka M et al. Multi-institutional experience of the ATS Open Pivot bileaflet valve in Japan. Ann Thorac Cardiovasc Surg. 1996;2(1):51-58.
• 28. Krian A. Clinical results of a large series of ATS valve implants. In: Krian A, Matloff JM, Nicoloff DM, eds. Advancing the Technology of Bileaflet Mechanical Heart Valves: 1st ed. Darmstad. Springer Verlag GmbH & Co. KG, 1998:53-71.
• 29. Jazayeri S, Gomez MC, Tatou E, Ecarnot A, Saleh M, Bouchot O et al. Clinical experience and Doppler echocardiographic assessment of the first one hundred ATS AP (advanced performance) prosthetic valve in the aortic position. J Heart Valve Dis. 2003;12(5):628-34.
• 30. Emery RW, Krogh CC, Jones DJ, Nicoloff DM, Blake DP, Arom KV. Five-year follow up of the ATS mechanical heart valve. J Heart Valve Dis. 2004;13(2):231-8.
• 31. Sezai A, Shiono M, Orime Y, Hata H, Yagi S, Negishi N et al. Evaluation of valve sound and its effects on ATS prosthetic valves in patient's quality of life. Ann Thorac Surg. 2000;69(2):507-12.
• 32. Sarıoglu T, Erek E, Kınoglu B, Salihoglu E, Şaşmazel A, Sarıoglu A, et al. Aort kapak hastalığında pulmoner otogreft (ross operasyonu) ve perikardiyal yaka tekniği. Türk Kardiyol Dern Arş. 2001;29(3):465-470. 33. Oury JH. Clinical aspects of the Ross procedure: Indications and contraindications. Sernin Thorac Cardiovasc Surg. 1996;8(4):328-35.
• 34. Schenider DJ, Moore JW. Aortic Stenosis. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF, eds. Moss&Adams’ Heart Disease in Infants, Children and Adolescents, Including the Fetus and Young Adult. 8th ed. Philadelphia. Lippincott Williams-Wilkins, 2013:1023-43.