GKD Anest Yoð Bak Dern Derg. 2016; 22(2): 75-81 | DOI: 10.5222/GKDAD.2016.075

Minimal invaziv mitral kapak cerrahisinde iki farklý yöntem: sað torakotomi ile minimal invaziv mitral kapak onarýmý ve atan kalpte transapikal Neokorda implantasyonu. Erken dönem sonuçlarýmýz

Ali Sait Kavaklý, Nilgün Kavrut Öztürk
Antalya Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Antalya

GÝRÝÞ ve AMAÇ: Günümüzde kardiyak cerrahide minimal invaziv cerrahinin kullanýmý cerrahi travmayý azaltmasý, yaþam kalitesini arttýrmasý, kozmetik sonuçlarýnýn daha iyi olmasý, postoperatif dönemde daha az aðrýlý olmasý, erken derlenme ve operatif mortaliteyi azaltmasý sebebiyle giderek yaygýnlaþmaktadýr.
Bu çalýþmanýn amacý kliniðimizde minimal invaziv mitral kapak cerrahisinde kullanýlan farklý iki tekniði ve bu tekniklerin erken dönem sonuçlarýný incelemektir.
YÖNTEM ve GEREÇLER: Ocak 2014-Þubat 2016 tarihleri arasýnda Antalya Eðitim ve Araþtýrma Hastanesi’nde mitral kapak patolojisi sebebiyle minimal invaziv cerrahi uygulanan 24 açýk kalp cerrahisi vakasýnýn (sað torakotomi ile kardiyopulmoner baypas eþliðinde minimal invaziv mitral kapak cerrahisi (STMÝMKC) ve sol torakotomi ile atan kalpte neokorda implantasyonu (AKTANÝ) verileri retrospektif olarak deðerlendirildi.
BULGULAR: STMÝMKC grubunda 12 hastaya mitral ring ile kapak tamiri yapýlýrken AKTANÝ grubunda 12 hastaya neokorda implantasyonu yapýldý.
Ameliyat süreleri, mekanik ventilasyon süreleri ve postoperatif dönemde yoðun bakýmda kullanýlan kan miktarý AKTANÝ grubunda anlamlý olarak düþük bulundu (P=0.020, 0.045 ve 0.036). Yoðun bakýmda ve hastanede kalýþ süreleri her iki grupta da benzerdi.
STMÝMKC grubunda 1 hasta postoperatif 6. saatte kanama sebebiyle tekrar operasyona alýndý. STMÝMKC grubunda 2 hastada postoperatif dönemde atelektazi geliþti. Ýnotrop ilaç infüzyonu kullanýmý STMÝMKC grubunda anlamlý olarak yüksek bulundu (P=0.032)
Hiçbir hastada postoperatif dönemde ve taburculuk sonrasý ilk 3 aylýk süre içinde mortaliteye rastlanmadý.
TARTIÞMA ve SONUÇ: STMÝMKC ve AKTANÝ teknikleri güvenli ve uygulanabilir tekniklerdir. Her iki tekniðin de kýsa dönem sonuçlarý olumludur. Uygun hastalarda AKTANÝ, mekanik ventilasyon ve hastanede kalýþ sürelerini kýsaltýr. Postoperatif kan kullaným oranýný azaltýr. Bununla beraber yöntem belirlenmesinde en önemli kriter uygun hasta seçimidir.

Anahtar Kelimeler: Minimal invaziv cerrahi, mitral kapak yetersizliði, sað anterolateral torakotomi, NeoChord prosedürü

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Two different methods of minimally invasive mitral valve surgery: minimally invasive mitral valve repair via right thoracotomy and transapical off-pump mitral valve repair with Neochord implantasyon. Early results

Ali Sait Kavaklý, Nilgün Kavrut Öztürk
Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey

INTRODUCTION: Minimally invasive surgery is used as an alternative method to conventional surgery in patients undergoing cardiac surgery. It provides to reduced surgical trauma, improved quality of life, better cosmesis, less painfull, early recovery, reduced operative mortality.
The aim of current study is to investigate different techniques which are used in minimally invasive mitral valve surgery in our hospital and to evaluate the early results.
METHODS: Between January 2014-February 2016; 24 patients undergoing minimally invasive surgery due to mitral valve pathology (minimally invasive mitral valve surgery via anterolateral thoracotomy (STMIMKC) and transapical off-pump mitral valve repair with Neochord implantation(AKTANI)) in Antalya Training and Research Hospital were evaluated retrospectively.
RESULTS: Mitral valve repair with mitral ring was performed in 12 patients in group STMIMKC. Neochord was implanted in 7 patients in group AKTANI.
Duration of surgery, duration of mechanical ventilation and amount of blood used in postoperatively was statistical lower in group AKTANI (P=0.020, 0.045 ve 0.036). Duration of intensive care and hospital stay was similar in both group. One patient in group STMIMKC was reoperated because of bleeding in postoperative 6th hour. Atelectasis was observed in two patients in group STMIMKC. Inotropic drug used was statitical higher in STMIMKC group (P=0.032).
There was no mortality in both groups in postoperative three months.
DISCUSSION AND CONCLUSION: STMIMKC ve AKTANI techniques are safety and feasible. Both techniques have positive short-term results. AKTANI is shortened the duration of mechanical ventilation and hospitalization and reduced the postoperative blood usage.
Patient selection is the most important criteria to appropriate method selection.

Keywords: Minimally invasive surgery, mitral valve regurgitation, right anterolateral thoracotomy, NeoChord procedure

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