Aort ve Mitral Kapak Replasmanı Sonrası Kalıcı Kalp Pili İmplantasyonunun Risk Faktörleri ve Sonuçları

Yıl 2022, , 247 - 253, 30.12.2022

Rezan Aksoy , Deniz Çevirme , Hakan Hançer , Tolga Bas Serdar Demir , Ali Karagoz Murat Bulent Rabus

https://doi.org/10.47572/muskutd.992741

Öz

Bu çalışmada, triküspit anüloplasti (TAP) olan/olmayan mitral kapak ve aort kapak replasmanlarını takiben kalıcı kalp pili implantasyonu (KKPI) için risk faktörlerinin araştırılması amaçlandı. Bu çalışmada Ocak 2014'ten Aralık 2017'ye kadar eşzamanlı TAP olan ve/veya olmayan aort kapak ve mitral kapak replasmanı yapılan hastalar geriye dönük olarak analiz edildi. Çalışmaya toplam 179 ardışık hasta (%48.0 erkek; ortalama yaş 51.7±13.7 yıl) dahil edildi; 165 (%92.17) hasta KKPI olmayan grubda ve 14 (%7.82) hasta KKPI olan gruptaydı. Toplam 179 ardışık hastanın %48.0’i erkek ve ortalama yaş 51.7±13.7 yıldır. İki grup yaş, cinsiyet, vücut kitle indeksi (VKİ), diabetes mellitus (DM), hipertansiyon (HT), ejeksiyon fraksiyonu % (%EF) ve kardiyopulmoner baypas (KPB) süresi açısından farklılık göstermedi (p>0.05). KKPI grubunda daha küçük boyutlarda mekanik veya biyolojik aort kapakları vardı (p˂0.05), önemli ölçüde daha yüksek bazal atriyal fibrilasyon (AF) oranı mevcuttu (p˂0.05). Geç ölüm oranları KKPI olamayan grupta ve KKPI olan gruplarda sırasıyla %10.9, %35.7 idi (p<0.05). KPI grubunda >2+ postoperatif tricuspid yetersizliği (TY) anlamlı olarak daha yüksekti (p<0.05). Daha dar ve kalsifik aort köklerine bağlı olabilecek KKPI grubunda mekanik veya biyolojik aort kapak boyutları anlamlı olarak daha küçüktü. Başlangıç AF'si olan hastaların yüzdesi KKPI grubunda daha fazlaydı. KKPI uygulanan hastalarda anlamlı derecede yüksek olan >2+ postoperatif TY bir risk faktörü olarak kabul edilemez ancak anlamlı bir sonuçtur.

Anahtar Kelimeler

aort kapak replasmanı, mitral kapak replasmanı, kalıcı pil implantasyonu

Risk Factors and Outcomes of Permanent Pacemaker Implantation Following Aortic and Mitral Valve Replacements

Öz

This study aimed to search risk factors for permanent pacemaker implantation (PPI) following mitral valve and aortic valve replacements with/without tricuspid annuloplasty (TAP). This study retrospectively analysed patients undergoing aortic valve and mitral valve replacements with/without concomitant TAP from January 2014 to December 2017. A total 179 consecutive patients were included into the study, 165 (92.17%) patients comprised no-PPI group and 14 (7.82%) comprised PPI group. A total 179 consecutive patients were 48.0% men; with the mean age 51.7±13.7 years. The two groups did not differ with respect to age, gender, body mass index (BMI), diabetes mellitus (DM), hypertension (HT), ejection fraction % (EF %) and the duration of cardiopulmonary bypass (CPB) (p>0.05). The PPI group had smaller sizes of mechanical or biological aortic valves (p˂0.05), with a significantly higher rate of baseline atrial fibrillation (AF) (p˂0.05). The late mortality rates were 10.9%, 35.7% in the no-PPI and the PPI groups, respectively (p<0.05). The PPI group had significantly higher > 2+ postoperative TR (p<0.05). The sizes of mechanical or biological aortic valves were significantly smaller in the PPI group, which may be due to the narrower and calcific aortic roots. The percentage of patients with a baseline AF was greater in the PPI group. The significantly higher incidence of >2+ postoperative TR among patients receiving PPIs can be deemed merely a result, but not a risk factor.

Anahtar Kelimeler

aortic valve replacement, mitral valve replacement, permanenet pacemaker implantation

Kaynakça

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