İSKEMİK MİTRAL YETMEZLİKTE KAPAK REPLASMANI VE TAMİR SONUÇLARININ KARŞILAŞTIRILMASI Comparison of the Surgical Results Between Valve Replacement and Repair in the Treatment of Mitral Insufficieny

Abstract

OZET Amac: Iskemik kalp hastaligina bagli gelisen mitral yetmezlik, halen operatif mortalitesi yuksek seyirli bir hastaliktir. Cerrahi prosedur olarak halen bir fikir birligi saglanmamistir. Bu calismada Iskemik Mitral Yetmezlikte (IMY), mitral kapak replasmani (MVR) ve tamir sonuclarinin karsilastirilarak, birbirlerine ustunluklerini ortaya koymak amaclanmistir. Materyal ve Metod: 2007 ve 2011 yillari arasinda Turkiye Yuksek Ihtisas Egitim ve Arastirma Hastanesi’nde, IMY nedeniyle opere edilen 36 hasta incelenmistir. Hastalarin (38.9%) kadin, 22’si (61.1%) erkekti. 20 hastaya MVR, 16 hastaya mitral rekonstruksiyon yapildi. Her iki grupta butun vakalarda koroner bypass mevcuttu. Hastalarda preoperatif risk faktorleri, mitral yetersizligin derecesi, sol ventrikul ejeksiyon fraksiyonlari, prepostoperatif fonksiyonel klasifikasyonlari, aort kros klemp ve kardiyopulmoner bypass sureleri, yogun bakim ve hastane kalis sureleri belirlendi. Bulgular: MVR yapilan grupta preoperatif diyastolik cap ve kontrol diyastolik cap arasinda anlamli olarak fark saptanmistir (p=0.016). Bu grupta diyastolik captaki duzelme tamir grubuna gore istatistiksel olarak daha iyi cikmistir. Ayrica preoperatif fonksiyonel kapasite (FK) ve kontrol FK arasinda, duzelme yonunde anlamli fark bulunmustur (p=0.008). Erken donem mortalite gorulen hastalar incelendiginde MVR yapilan grupta 6 hasta, tamir grubunda 5 hasta exitus oldu. Mortalite gorulen 11 hasta ile sag kalan hastalar preoperatif ejeksiyon fraksiyonu (EF) yonunden karsilastirildiginda anlamli bir fark bulunmamistir (p=0.986) Sonuc: IMY‘de oncelikle mitral tamir onerilse de, son zamanlarda bazi calismalarda da onerildigi gibi, MVR yapilmasi mitral yetmezligin tam giderilmesini saglayip, reoperasyon riskini azaltmaktadir. Anahtar Sozcukler; Iskemik Mitral Yetmezlik, Koroner Arter ByPass, Mitral Kapak Replasmani, Mitral Tamir ABSTRACT Objective: Mitral insufficiency due to ischemic heart disease is still a disease with high operative mortality. There is still no consensus as surgical procedure. In this study, it is aimed to reveal the superiority of ischemic mitral insufficiency (IMI), mitral valve replacement (MVR) and repair results. Materials and Methods: 2007 and High-Turkey Training and Research Hospital between the years of 2011, 36 patients were operated for IMI was examined. The patients (38.9%) were female and 22 (61.1%) were male. MVR was performed in 20 patients and mitral reconstruction was performed in 16 patients. There was coronary bypass in all cases. Preoperative risk factors, degree of mitral regurgitation, left ventricular ejection fractions, pre-postoperative functional classifications, aortic cross clamp and cardiopulmonary bypass duration, intensive care and hospital stay were determined. Results: There was a significant difference between preoperative diastolic diameter and control diastolic diameter in the MVR group (p = 0.016). In this group diastolic diametric improvement was statistically better than the repair group. Furthermore, there was a significant difference between the preoperative functional capacity (FC) and control FC in terms of improvement (p = 0.008). When the patients with early mortality were examined, 6 patients in the MVR group and 5 patients in the repair group died. There was no significant difference between 11 patients with mortality and the survivors in terms of preoperative ejection fraction (EF) (p = 0.986). Conclusion: Although mitral repair is recommended in IMI, as recently suggested in some studies, MVR provides complete removal of mitral insufficiency and reduces the risk of reoperation. Keywords: Ischemic Mitral Insufficiency, Coronary Artery By-Pass Grafting, Mitral Valve Replacement, Mitral Repair