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The relation between location of paravalvular leakage and time to reoperation after mitral valve replacement [Anatol J Cardiol]
Anatol J Cardiol. 2014; 14(1): 61-67 | DOI: 10.5152/akd.2013.225  

The relation between location of paravalvular leakage and time to reoperation after mitral valve replacement

Mehmet Yanartaş1, Serdar Demir2, Ayşe Baysal3, Ali Fedakar4, Elnur Alizade5, Müslüm Şahin2, Serpil Taş6, Hasan Sunar4
1Clinic of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Education and Research Hospital, İstanbul
2Clinic of Cardiology, Kartal Koşuyolu Yüksek İhtisas Education and Training Hospital, İstanbul-Turkey
3Clinic of Anesthesiology and Reanimation, Kartal Koşuyolu Training and Research Heart Hospital, İstanbul-Turkey
4Clinic of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Education and Training Hospital, İstanbul-Turkey
5Clinic of Cardiology, Kartal Koşuyolu Heart Education and Training Hospital, İstanbul-Turkey
6Clinics of Cardiovascular Surgery Kartal Koşuyolu Yüksek İhtisas Education and Training Hospital; İstanbul-Turkey

Objective: A relation between the location of the paravalvular leakage (PVL) and time to reoperation after mitral mechanical valve replacement was investigated. Methods: In an observational retrospective study plan, from 59 patients who underwent reoperation only 47 patients having clinical and echocardiographic follow-up for five years were included into study. Depending on echocardiographic evaluation of location of leak, patients were divided into Group 1 (Leaflet) and Group 2 (Commissural). Demographics, preoperative variables, causes of reoperation, the time period between diagnosis of PVL and reoperation were recorded. Unpaired t test or Mann-Whitney U test were used for comparison of variables between groups. Results: A PVL was diagnosed after a median time of 180 days (range: 1 day-28 years) after the first mitral valve replacement. The median follow-up period was 5 years (range; 1-16 years). Age, gender, left ventricular ejection function, number and size of leaks did not differ between groups (p>0.05). The time period between diagnosis and reoperation time was longer in Group 1 in comparison to Group 2 (39.0±9.9 vs. 19.5±12.8 months, p=0.002). The 30-day mortality for valve reoperation was 4.3% (2/47). In Group 1, 2 patients (2/21, 9.8%) died whereas, no death was observed in Group 2 (0/26, 0%) (p=0.002). Conclusion: The time period between diagnosis and reoperation was longer in leaflet leak group in comparison to commissural leak group. We suggest echocardiographic evaluation should include location of the paravalvular leakage during follow-up of patients with PVL after mitral valve replacement.

Keywords: paravalvular leak, mitral valve surgery, reoperation, transthoracic echocardiography


Mitral kapak replasmanı sonrası paravalvüler kaçak lokalizasyonu ile reoperasyon zamanı arasındaki ilişki: Gözlemsel bir çalışma

Mehmet Yanartaş1, Serdar Demir2, Ayşe Baysal3, Ali Fedakar4, Elnur Alizade5, Müslüm Şahin2, Serpil Taş6, Hasan Sunar4
1Clinic of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Education and Research Hospital, İstanbul
2Clinic of Cardiology, Kartal Koşuyolu Yüksek İhtisas Education and Training Hospital, İstanbul-Turkey
3Clinic of Anesthesiology and Reanimation, Kartal Koşuyolu Training and Research Heart Hospital, İstanbul-Turkey
4Clinic of Cardiovascular Surgery, Kartal Koşuyolu Yüksek İhtisas Education and Training Hospital, İstanbul-Turkey
5Clinic of Cardiology, Kartal Koşuyolu Heart Education and Training Hospital, İstanbul-Turkey
6Clinics of Cardiovascular Surgery Kartal Koşuyolu Yüksek İhtisas Education and Training Hospital; İstanbul-Turkey

Amaç: Mitral kapak ameliyatı sonrası paravalvüler kaçak ameliyatında kaçağın lokalizasyonunun tanı ile reoperasyon zamanı arasındaki ilişkisi araştırıldı. Yöntemler: Gözlemsel retrospektif bir çalışma planı ile reoperasyona alınan 59 hastadan, beş yıllık klinik ve ekokardiyografik takibi olan 47 hasta çalışmaya dahil edildi. Ekokardiyografik inceleme ile kaçak bölgesinin yerine göre hastalar Grup 1 (Leaflet grubu) ve Grup 2 (Kommisüral) olmak üzere iki gruba ayrıldı. Demografik veriler, preoperatif veriler, re-operasyon nedenleri ve hastanın ilk paravalvüler kaçak tanısı alması ile reoperasyonu arasındaki zaman periyodu kaydedildi. Hasta grupları eşleştirilmiş ve Mann-Whitney U testleri ile değerlendirildi. Bulgular: İlk mitral kapak ameliyatından medyan 180 gün (1 gün-28 yıl) sonra paravalvüler kaçak tanısı kondu. Medyan takip zamanı 5 yıl (1-16 yıl) idi. Yaş, cinsiyet, sol ventrikül ejeksiyon fraksiyonu, kaçak sayısı ve miktarı gruplar arasında farklı değildi (p>0,05). Tanı ile reoperasyon zamanı arasındaki zaman Grup 1’de Grup 2’ye göre daha uzundu (39,0±9,9 vs. 19,5±12,8 ay, p=0,002). Otuz günlük mortalite %4,3 (2/47) idi. Grup 1’de mortalite 2 hastada gözlenirken (2/21, %9,8) Grup 2’de mortalite yoktu (0/26, %0) (p=0,002). Sonuç: Paravalvüler kaçak tanısı konması ile reoperasyona alınma arasında geçen süre, leaflet grubunda kommissür grubuna göre daha uzundu. Biz mitral kapak replasmanı sonrası paravalvüler kaçak gözlenen hastaların takibindeki ekokardiyografik değerlendirmede paravalvüler kaçağın yerinin belirtilmesini öneriyoruz.

Anahtar Kelimeler: Paravalvüler kaçak, mitral kapak cerrahisi, reoperasyon, transtorasik ekokardiyografi


Mehmet Yanartaş, Serdar Demir, Ayşe Baysal, Ali Fedakar, Elnur Alizade, Müslüm Şahin, Serpil Taş, Hasan Sunar. The relation between location of paravalvular leakage and time to reoperation after mitral valve replacement. Anatol J Cardiol. 2014; 14(1): 61-67


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