İzole aort darlığı nedeniyle opere edilen hastalarda sol ventrikül hipertrofisinin incelenmesi
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Tarih
2022
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Aort darlığı hastalarında şiddetli sol ventrikül hipertrofisi ve eksik gerilemesi görülebilir. Başarıyla gerçekleştirilen aort kapak replasmanı sonrasında bile daha kötü sol ventrikül fonksiyonu, daha yüksek erken ve geç mortalite görülebilir. Biz de bu çalışmamızda, izole aort darlığı nedeniyle opere edilen hastalarda kullanılan kapak çeşitlerinin sol ventrikül hipertrofisinin gerilemesi üzerine olan etkilerini incelemeyi amaçladık. Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Kalp ve Damar Cerrahisi Kliniği’nde 2010-2020 yılları arasında aort darlığı nedeniyle izole aort kapak replasmanı yapılan hastalar retrospektif olarak incelendi. Toplam 290 hastadan daha önce kardiyak operasyon öyküsü olan, ek prosedür (Koroner arter bypass greft [KABG], asendan aort replasmanı, kök genişletilmesi vs.) uygulanan, 18 yaş altı, gebe ve/veya emziren, acil alınan, infektif endokardit ve aort yetmezliği ana tanısı olan hastalar çalışma dışı bırakılarak 199 hasta retrospektif olarak incelendi. Kullanılan kapak çeşidine göre hastalar 4 gruba ayrıldı (bovine perikard, biyolojik porcine, dikişsiz ve mekanik kapak). Hastaların demografik verileri, preop ve post op 1. yıl transtorasik ekokardiyografi (EKO) değişimleri, kardiyopulmoner bypass (KPB) ve kross klemp zamanı, kullanılan kapak çeşidi, numaraları, sol ventrikül kitlesi (SVK) ve sol ventrikül kitle indeksi (SVKİ) karşılaştırıldı.
Bulgular: Hastaların %41,7’sini (n=83) kadın ve %58,3’ünü (n=116) erkek cinsiyet oluşturmaktadır. 78 hastada (%39,2) mekanik kapak, 36 hastada (%18,1) biyolojik porcine, 17 hastada (%8,5) bovine perikard ve 68 hastada (%34,2) dikişsiz (sutureless) kapak kullanılmıştır. SVK 228,76±66,61 g’dan 1. yıl sonunda 185,29±44,42 g’a anlamlı gerilediği (p<0,001), SVKİ 124,15±34,46 g/m²’den 1. yıl sonunda 100,35±22,31 g/m²’ye anlamlı gerilediği (p<0,001) görüldü. Ortalama transaortik basınç farkı 52,46±13,83 mmHg’den 13,50±6,85 mmHg’ye anlamlı gerilediği (p<0,001) saptandı. Bu hastaların 1. yıl takibinde sol ventrikül ejeksiyon fraksiyonunun (EF) anlamlı olarak arttığı (p=0,008) görüldü. Kapak çeşitlerine göre oluşturulan alt grup analizinde ise bütün gruplarda sol ventrikül end sistolik volüm (LVESD), Max Gradient, Mean Gradient, SVK ve SVKİ ortalamaları postoperatif dönemde anlamlı olarak geriledi. Bütün kapak grupları hasta protez uyumsuzluğu (PPM) açısından incelendiği zaman; ağır, orta ve normal olarak gruplandırıldığında, LVESD, Max Gradient, Mean Gradient, Pulmoner Arter Basıncı (PAB), SVK ve SVKİ ortalamalarının bütün gruplarda postoperatif dönemde anlamlı olarak gerilediği görüldü. PPM açısından normal olan grupta diğer gruplardan farklı olarak EF’de önemli miktarda iyileşme olduğu (p=0,001) görüldü. Sonuç: SVK ve SVKİ gerilemesi birçok faktörden etkilenen karmaşık bir olgudur. Çalışmamızda izole aort darlığı olan hastalara uygulanan aort kapak replasmanı sonrası hastalarda anlamlı SVK ve SVKİ gerilemesi görüldü. Bu kitle gerilemesinin kapak çeşidinden ve hasta protez uyumsuzluğundan bağımsız olarak gerçekleştiği tespit edildi.
Severe left ventricular hypertrophy due to aortic stenosis and its incomplete regression are associated with poor left ventricular function and increased early/late mortality, even with aortic valve replacement. In this study, we aim to evaluate left ventricular hypertrophy in patients operated for isolated aortic stenosis. Materials/Methods: The retrospective evaluation of patients with aortic stenosis who underwent isolated aortic valve replacement between the years 2010-2020 at the Department of Cardiovascular Surgery of Necmettin Erbakan University, Meram Faculty of Medicine. A total of 290 patients were initially considered. The exclusion criteria included history of cardiac operation, additional interventions (coronary artery bypass graft (CABG), ascending aorta replacement, aortic root expansion), <18 years of age, pregnancy/lactation, emergency patients and those with a primary diagnosis of aortic regurgitation; with this considered, 199 patients were included and retrospectively evaluated. The patients were divided into 4 groups according to valve type (bovine pericardium, biological porcine, sutureless and mechanical valve). The patients were compared with respect to demographic characteristics, pre-op and post-op 1st year transthoracic echocardiography changes, cardiopulmonary bypass (CBP) and cross-clamp time, valve type, number, left ventricular mass (LVM) and left ventricular mass index (LVMI). Results: The gender distribution of patients were 41.7% (n=83) female and 58.3% (n=116) male. The valves used were 78 (39.2%) mechanical valve, 36 (18.1%) biological porcine, 17 (8.5%) bovine pericardium and 68 (34.2%) sutureless. The LVM regressed from 228,76±66,61 g to 185,29±44,42 g at the end of the 1st year, while the LVMI regressed significantly from 124,15±34,46 g/m² to 100,35±22,31 g/m² at the end of the 1st year. The mean transthoracic pressure gradient regressed significantly from 52,46±13,83 mmHg to 13,50±6,85 mmHg. At the 1 year check-up, the patients had significantly increased left ventricular ejection fraction (LVEF). In the analysis according to valve type; in the post-operative period, all groups exhibited significant regression in values of left ventricular end diastolic volume (LVEDS), max gradient, mean gradient, pulmonary artery pressure (PAP), LVM and LVMI. In the comparison of valve types with respect to patient prosthesis mismatch (PPM); the groups were classified severe, moderate and normal, and all groups showed post-operative regression in values of left ventricular end diastolic volume (LVEDS), max gradient, mean gradient, pulmonary artery pressure (PAP), LVM and LVMI. Furthermore, the normal PPM group demonstrated significantly better improvement in LVEF compared to the severe and moderate groups. Conclusion: The regression of LVM and LVMI is affected by several factors. In our study, we observed significant regression of LVM and LVMI in patients with isolated aortic stenosis following aortic valve replacement. This mass regression occurred independent of valve type used as well as patient prosthesis mismatch.
Severe left ventricular hypertrophy due to aortic stenosis and its incomplete regression are associated with poor left ventricular function and increased early/late mortality, even with aortic valve replacement. In this study, we aim to evaluate left ventricular hypertrophy in patients operated for isolated aortic stenosis. Materials/Methods: The retrospective evaluation of patients with aortic stenosis who underwent isolated aortic valve replacement between the years 2010-2020 at the Department of Cardiovascular Surgery of Necmettin Erbakan University, Meram Faculty of Medicine. A total of 290 patients were initially considered. The exclusion criteria included history of cardiac operation, additional interventions (coronary artery bypass graft (CABG), ascending aorta replacement, aortic root expansion), <18 years of age, pregnancy/lactation, emergency patients and those with a primary diagnosis of aortic regurgitation; with this considered, 199 patients were included and retrospectively evaluated. The patients were divided into 4 groups according to valve type (bovine pericardium, biological porcine, sutureless and mechanical valve). The patients were compared with respect to demographic characteristics, pre-op and post-op 1st year transthoracic echocardiography changes, cardiopulmonary bypass (CBP) and cross-clamp time, valve type, number, left ventricular mass (LVM) and left ventricular mass index (LVMI). Results: The gender distribution of patients were 41.7% (n=83) female and 58.3% (n=116) male. The valves used were 78 (39.2%) mechanical valve, 36 (18.1%) biological porcine, 17 (8.5%) bovine pericardium and 68 (34.2%) sutureless. The LVM regressed from 228,76±66,61 g to 185,29±44,42 g at the end of the 1st year, while the LVMI regressed significantly from 124,15±34,46 g/m² to 100,35±22,31 g/m² at the end of the 1st year. The mean transthoracic pressure gradient regressed significantly from 52,46±13,83 mmHg to 13,50±6,85 mmHg. At the 1 year check-up, the patients had significantly increased left ventricular ejection fraction (LVEF). In the analysis according to valve type; in the post-operative period, all groups exhibited significant regression in values of left ventricular end diastolic volume (LVEDS), max gradient, mean gradient, pulmonary artery pressure (PAP), LVM and LVMI. In the comparison of valve types with respect to patient prosthesis mismatch (PPM); the groups were classified severe, moderate and normal, and all groups showed post-operative regression in values of left ventricular end diastolic volume (LVEDS), max gradient, mean gradient, pulmonary artery pressure (PAP), LVM and LVMI. Furthermore, the normal PPM group demonstrated significantly better improvement in LVEF compared to the severe and moderate groups. Conclusion: The regression of LVM and LVMI is affected by several factors. In our study, we observed significant regression of LVM and LVMI in patients with isolated aortic stenosis following aortic valve replacement. This mass regression occurred independent of valve type used as well as patient prosthesis mismatch.
Açıklama
Anahtar Kelimeler
Sol ventrikül kitlesi, Sol ventrikül kitle indeksi, Aort darlığı, Aortik protezler, Left ventricular mass, Left ventricular mass index, Aortic stenosis, Aortic prosthesis
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Künye
Güner, A. (2022). İzole aort darlığı nedeniyle opere edilen hastalarda sol ventrikül hipertrofisinin incelenmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Kalp ve Damar Cerrahisi Anabilim Dalı, Konya.
