Fonksiyonel triküspit yetmezliğinde de vega anüloplasti ile kalangos biodegradabl ring anüloplastinin erken ve orta dönem sonuçlarının karşılaştırılması
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Dosyalar
Tarih
2009
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Trakya Üniversitesi Tıp Fakültesi
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Sol kalp kapak hastalıkları veya diğer sebeplere bağlı gelişen fonksiyonel triküspit yetmezliği primer cerrahiyle eş zamanlı tedavi edilmezse postoperatif dönemde hastanın morbidite ve mortalitesini arttırmaktadır. Günümüzde sol taraf kalp kapak patolojilerine sekonder gelişen triküspit kapak fonksiyonel yetmezliğinin cerrahi olarak tedavi edilmesi gerektiği konusunda genel olarak görüş birliğine varılmıştır. Trakya Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Kliniği'nde primer patolojilerinin yanında fonksiyonel triküspit yetmezliği sebebiyle triküspit tamiri de yapılan elektif şartlarda opere edilmiş 20 hasta rızaları alınarak çalışmaya dahil edildiler. Hastalar fonksiyonel triküspit yetmezliği sebebiyle primer cerrahinin yanında triküspit kapak Kalangos Bioring anüloplasti uygulanan grup ve primer cerrahinin yanında triküspit kapak De Vega anüloplasti uygulanan grup olmak üzere iki gruba ayrıldılar. Hastaların preoperatif karakteristik özelliklerine, preoperatif, postoperatif erken dönem, 3. ay ve 6. ayda New York Heart Association fonksiyonel sınıflamaya ve ekokardiyografik özelliklerine, intraoperatif kros klemp zamanına ve kardiyopulmoner ?bypass? zamanına, postoperatif yoğun bakım ünitesi ve hastanede kalış sürelerine, yeni atrial fibrilasyon gelişme oranlarına bakıldı. Gruplar arasında cinsiyet, yaş, vücut yüzey alanı, geçirilmiş kalp cerrahisi öyküsü ve diğer karakteristik özellikler bakımından istatistiksel olarak anlamlı fark yoktu. Gruplar arasında New York Heart Association fonksiyonel sınıflaması, sağ atrium, sağ ventrikül, pulmoner arter basıncı ve triküspit yetmezlik dereceleri bakımından aralarında istatistiksel olarak anlamlı fark yoktu. Bununla birlikte gruplar kendi içlerinde değerlendirildiklerinde preoperatif ve postoperatif 6. ay New York Heart Association sınıflaması, sağ atrium, pulmoner arter basıncı ve triküspit yetmezlik derecelerindeki azalmaların istatistiksel olarak anlamlı olduğu görüldü. Ek olarak Kalangos Bioring uygulanan grupta postoperatif erken dönemde yeni gelişen atriyal fibrillasyon hiçbir hastada görülmezken De Vega uygulanan grupta preoperatif sinüs ritminde olan 4 hastanın 3'ünde postoperatif erken dönemde yeni gelişen atriyal fibrillasyon ritmi saptandı. Bu parametre açısından istatistiksel olarak anlamlıya yakın sonuç olduğu görüldü. Sonuç olarak fonksiyonel triküspit yetmezliğinin primer patoloji ile eş zamanlı düzeltilmesi gerektiğini ve tamir sonrasında postoperatif New York Heart Association fonksiyonel kapasite, sağ atriyum çapı, sağ ventrikül çapı, pulmoner arter basıncı ve triküspit yetmezlik derecelerinin takipte kullanılabileceğini düşünmekteyiz. Bu çalışma bize Kalangos biodegradabl ringin triküspit kapak tamirlerinde güvenle kullanılabilecek etkin bir yöntem olduğunu göstermektedir. Bu parametreler bakımından incelendiğinde Kalangos Bioring anüloplasti yapılan grubun erken ve orta dönem sonuçlarının daha olumlu olduğu kanısındayız.
Abstract
Functional tricuspid regurgitation that caused by left heart valve pathology or other reasons increased morbidity and mortality rates in postoperative period if it could not repaired contemporarly with primary surgery. Nowadays, there was generally a consensus for surgical correction of functional tricuspid regurgitation that caused by left heart valve pathology. Total 20 patients that undergone elective tricuspid repairing with primary surgery for functional tricuspid regurgitation included to the study in Trakya University Faculty of Medicine Cardiovascular Surgery Clinic. Informed consent was obtained from all patients. Patients that operated contemporarly tricuspid repair with primary surgery for functional tricuspid regurgitation were grouped into two; Kalangos Bioring annuloplasty group and De Vega annuloplasty group. Preoperative characteristics of patients, preoperative, postoperative early period, 3th mount and 6th mount echocardiographic features and New York Heart Associaion functional capacity of patients, intraoperative cross clemp and cardiopulmonary bypass time, postoperative intensive care unit and hospital stay time and recent atrial fibrillation occurrence percentages were checked. There was no statistically significant difference to be in favour of groups in terms of gender, age, body surface area, history of redo heart surgery and other charactheristic features. There was no statiscally significant difference between groups in terms of New York Heart Associaion functional classification, right atrium, right ventricule, pulmonar artery presssure and tricupid regurgitation degree. However there was statiscally significant difference inside groups themselves in terms of preoperative and postoperative 6th mount decreament of New York Heart Associaion functional classification, right atrium, pulmonar artery presssure and tricupid regurgitation degree. In addition, there was not detected recent occurance atrial fibrillation in Kalangos Bioring but in De Vega group 3 in 4 patients that had sinus rtyhm preoperatively had recent atrial fibrillation in postoperative early period. There was statiscally closed significant difference for this parameter. In conclusion, we think that functional tricuspid regurgitation contemporaryly treated with primary surgery and to use postoperative New York Heart Associaion functional classification, right atrium diameter, right ventricule diameter, pulmonary artery pressure and tricuspid regurgitation degree for follow up. This study showed us Kalangos biodegradabl ring implantation that can be used safely is an effective method for tricuspid valve repair. We consider Kalangos Bioring group that analysed for these parameters has more favourable early and midterm results.
Abstract
Functional tricuspid regurgitation that caused by left heart valve pathology or other reasons increased morbidity and mortality rates in postoperative period if it could not repaired contemporarly with primary surgery. Nowadays, there was generally a consensus for surgical correction of functional tricuspid regurgitation that caused by left heart valve pathology. Total 20 patients that undergone elective tricuspid repairing with primary surgery for functional tricuspid regurgitation included to the study in Trakya University Faculty of Medicine Cardiovascular Surgery Clinic. Informed consent was obtained from all patients. Patients that operated contemporarly tricuspid repair with primary surgery for functional tricuspid regurgitation were grouped into two; Kalangos Bioring annuloplasty group and De Vega annuloplasty group. Preoperative characteristics of patients, preoperative, postoperative early period, 3th mount and 6th mount echocardiographic features and New York Heart Associaion functional capacity of patients, intraoperative cross clemp and cardiopulmonary bypass time, postoperative intensive care unit and hospital stay time and recent atrial fibrillation occurrence percentages were checked. There was no statistically significant difference to be in favour of groups in terms of gender, age, body surface area, history of redo heart surgery and other charactheristic features. There was no statiscally significant difference between groups in terms of New York Heart Associaion functional classification, right atrium, right ventricule, pulmonar artery presssure and tricupid regurgitation degree. However there was statiscally significant difference inside groups themselves in terms of preoperative and postoperative 6th mount decreament of New York Heart Associaion functional classification, right atrium, pulmonar artery presssure and tricupid regurgitation degree. In addition, there was not detected recent occurance atrial fibrillation in Kalangos Bioring but in De Vega group 3 in 4 patients that had sinus rtyhm preoperatively had recent atrial fibrillation in postoperative early period. There was statiscally closed significant difference for this parameter. In conclusion, we think that functional tricuspid regurgitation contemporaryly treated with primary surgery and to use postoperative New York Heart Associaion functional classification, right atrium diameter, right ventricule diameter, pulmonary artery pressure and tricuspid regurgitation degree for follow up. This study showed us Kalangos biodegradabl ring implantation that can be used safely is an effective method for tricuspid valve repair. We consider Kalangos Bioring group that analysed for these parameters has more favourable early and midterm results.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Triküspit Kapak, Cerrahi-fonksiyonel Triküspit Yetmezliği, Kapak Tamiri, Anüloplasti, Tricuspid Valve, Surgery-functional Tricuspid Valve, Valve Repair, Annuloplasty
