Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Onan, Burak; KORKMAZ, Aşkın Ali; AKDEMİR, İlyas; DEMİR, Ali Soner; güden, mustafa; TARAKÇI İNDELEN, Sevim; GÜNDOĞDU, Recep

Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Aşkın Ali KORKMAZ, (Sema Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, Türkiye)

Burak ONAN, (Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, Göğüs Cerrahisi Kliniği, İstanbul, Türkiye)

Ali Soner DEMİR, (Sema Hastanesi, Kardiyoloji Kliniği, İstanbul, Türkiye)

Sevim TARAKÇI İNDELEN, (Sema Hastanesi, Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Türkiye)

Recep GÜNDOĞDU, (Sema Hastanesi, Kardiyoloji Kliniği, İstanbul, Türkiye)

İlyas AKDEMİR, (Sema Hastanesi, Kardiyoloji Kliniği, İstanbul, Türkiye)

Mustafa GÜDEN (Sema Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, Türkiye)

Anadolu Kardiyoloji Dergisi

2 5

Yıl: 2011 Cilt: 11 Sayı: 6 Sayfa Aralığı: 542 - 550 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Öz:

Amaç: Mitral kapak tamiri günümüz kalp cerrahisinde mitral yetmezliğin her tipinde ilk seçenek olarak akla gelmelidir. Çalışmamızda ciddi mitral yetersizlik nedeniyle uygulanan mitral kapak tamirlerinin klinik sonuçlarını değerlendirdik. Yöntemler: Bu prospektif kohort çalışmada mitral kapak tamiri planlanan 103 hastamızın (61 erkek, 42 kadın) ortalama yaşı 53.2±14.8 idi. Mitral kapak patolojisi hastaların %86’sında yetmezlik ve %14’ünde karışık tipti. Yüz (%97.1) hastada tamir girişimi başarılı idi. Ek cerrahi girişim 57 (%57) hastada yapıldı, bunların 31’i koroner arter baypas ve 13’ü triküspit kapak tamiri şeklindeydi. Ameliyat sonrası erken (<30 gün) ve geç (>30 gün) dönem komplikasyonlar araştırıldı. Tüm hastalara taburcu olduklarında ve klinik takip sırasında ekokardiyografi yapıldı. Geç hayatta kalım ve tromboembolizm, endokardit, reoperasyon ve rezidüel ciddi mitral yetersizlikten gibi istenmeyen olaylardan bağımsız olma oranları Kaplan-Meier sağkalım analizi ile değerlendirildi. Bulgular: Erken mortalite görülmedi. Hastalar taburcu olduğunda yapılan ekokardiyografik değerlendirmede %89’unda hiç/eser yetersizlik ve %11’inde hafif (+1) yetersizlik saptandı. Geç mortalite 14. ayda renal yetersizlik nedeniyle sadece 1 hastada gözlendi. Hastalarımızın ortalama takip süresi 21.2±10.3 aydı. Takipler sırasında yapılan ekokardiyografik değerlendirmede hastaların %96’sında hiç ya da hafif yetersizlik gözlendi. Orta (+2)yetersizlik gözlenen üç (%3) hastada tıbbi tedavi uygulandı. İleri (3+) yetersizlik gözlenen bir (%1) hastada koroner baypas cerrahisi ile birlikte sol ventrikül anevrizmektomi ameliyatı yapılmıştı. Hastaların sadece birinde (%1) re-operasyon gerekli oldu, enfektif endokardit olan bu hastada mekanik kapak replasmanı yapıldı. Kaplan-Meier tahminleri geç hayatta kalım için %99±2.7 iken tromboemboli, endokardit, reoperasyon ve kalıcı ciddi mitral yetersizlikten bağımsız yaşam için sırasıyla %98±2.2, %99±2.7, %99±2.7 ve %99±0.9 idi. Sonuç: Çalışmamızda mitral kapak tamiri sonuçlarının mükemmel olduğu görüldü. Cerrahi tamir teknikleri güvenli ve sonuçları son derece etkindir, fakat cerrahi tecrübenin yeterli olması gereklidir. (Anadolu Kardiyol Derg 2011; 11: 542-50)

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Mitral yetersizliğinde mitral kapak onarımının klinik sonuçları: Ardışık 100 hastanın prospektif analizi

Öz:

Objective: Mitral valve repair has become the procedure of choice for almost every type of mitral regurgitation (MR) in the current surgical era. We assessed clinical outcomes of mitral valve repair in severe MR. Methods: In this prospective cohort study, 103 patients (61 male, 42 female, mean age 53.2±14.8 years), who were planned to undergo valve repair were included. Mitral valve pathology was regurgitant in 86% and mixed in 14% of patients. The intention to perform mitral repair was successful in 100 (97.1%) of patients. Concomitant procedures were performed in 57 (57%) patients including 31 coronary artery bypass grafting and 13 tricuspid valve repairs. After surgery, early (<30 days) and late (>30 days) complications were recorded. Postoperative echocardiography was performed in all patients at discharge and during clinical follow-up. Late survival and freedom from adverse events including thromboembolism, endocarditis, reoperation, and residual severe MR were estimated by using the Kaplan-Meier survival analysis. Results: There was no early mortality. Echocardiographic assessment of patients at discharge revealed no/trivial regurgitation in 89% and mild (1+) MR in 11% of all patients. Late mortality occurred in only one patient at 14 months because of renal failure. The mean follow-up period of patients was 21.2±10.3 months. Echocardiographic examination during follow-up revealed that mitral insufficiency was none or mild in 96% of patients. Three (3%) patients had moderate (2+) MR and were treated medically. Mitral insufficiency recurrence with severe (3+) regurgitation occurred in one (1%) patient undergoing coronary artery revascularization and concomitant left ventricular aneurysmectomy. Re-operation was needed in only one (1%) case because of infective endocarditis that was treated with mechanical valve replacement. Kaplan-Meier estimates were 99±2.7% for late survival and 98±2.2%, 99±2.7%, 99±2.7% and 99±0.9% for freedom from thromboembolism, endocarditis, reoperation, and residual severe MR, respectively. Conclusion: This study showed that mitral valve repair provides excellent surgical outcomes. Repair procedures are safe, and highly effective, but operations require a considerable surgical experience. (Anadolu Kardiyol Derg 2011; 11: 542-50)

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	KORKMAZ A, Onan B, DEMİR A, TARAKÇI İNDELEN S, GÜNDOĞDU R, AKDEMİR İ, güden m (2011). Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. , 542 - 550.
Chicago	KORKMAZ Aşkın Ali,Onan Burak,DEMİR Ali Soner,TARAKÇI İNDELEN Sevim,GÜNDOĞDU Recep,AKDEMİR İlyas,güden mustafa Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. (2011): 542 - 550.
MLA	KORKMAZ Aşkın Ali,Onan Burak,DEMİR Ali Soner,TARAKÇI İNDELEN Sevim,GÜNDOĞDU Recep,AKDEMİR İlyas,güden mustafa Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. , 2011, ss.542 - 550.
AMA	KORKMAZ A,Onan B,DEMİR A,TARAKÇI İNDELEN S,GÜNDOĞDU R,AKDEMİR İ,güden m Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. . 2011; 542 - 550.
Vancouver	KORKMAZ A,Onan B,DEMİR A,TARAKÇI İNDELEN S,GÜNDOĞDU R,AKDEMİR İ,güden m Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. . 2011; 542 - 550.
IEEE	KORKMAZ A,Onan B,DEMİR A,TARAKÇI İNDELEN S,GÜNDOĞDU R,AKDEMİR İ,güden m "Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients." , ss.542 - 550, 2011.
ISNAD	KORKMAZ, Aşkın Ali vd. "Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients". (2011), 542-550.

APA	KORKMAZ A, Onan B, DEMİR A, TARAKÇI İNDELEN S, GÜNDOĞDU R, AKDEMİR İ, güden m (2011). Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. Anadolu Kardiyoloji Dergisi, 11(6), 542 - 550.
Chicago	KORKMAZ Aşkın Ali,Onan Burak,DEMİR Ali Soner,TARAKÇI İNDELEN Sevim,GÜNDOĞDU Recep,AKDEMİR İlyas,güden mustafa Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. Anadolu Kardiyoloji Dergisi 11, no.6 (2011): 542 - 550.
MLA	KORKMAZ Aşkın Ali,Onan Burak,DEMİR Ali Soner,TARAKÇI İNDELEN Sevim,GÜNDOĞDU Recep,AKDEMİR İlyas,güden mustafa Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. Anadolu Kardiyoloji Dergisi, vol.11, no.6, 2011, ss.542 - 550.
AMA	KORKMAZ A,Onan B,DEMİR A,TARAKÇI İNDELEN S,GÜNDOĞDU R,AKDEMİR İ,güden m Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. Anadolu Kardiyoloji Dergisi. 2011; 11(6): 542 - 550.
Vancouver	KORKMAZ A,Onan B,DEMİR A,TARAKÇI İNDELEN S,GÜNDOĞDU R,AKDEMİR İ,güden m Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients. Anadolu Kardiyoloji Dergisi. 2011; 11(6): 542 - 550.
IEEE	KORKMAZ A,Onan B,DEMİR A,TARAKÇI İNDELEN S,GÜNDOĞDU R,AKDEMİR İ,güden m "Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients." Anadolu Kardiyoloji Dergisi, 11, ss.542 - 550, 2011.
ISNAD	KORKMAZ, Aşkın Ali vd. "Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients". Anadolu Kardiyoloji Dergisi 11/6 (2011), 542-550.