Oğuz KARAHAN, Şinasi MANDUZ, Umut Sehat SANRI, Ekber ŞAHİN, Nurkay KATRANCIOĞLU

Asendan aort cerrahisi deneyimlerimiz

Amaç. Son yıllarda cerrahi tekniklerdeki önemli gelişmelere rağmen, asendan aortayı tutan patolojiler ciddi mortalite ve morbidite oranları nedeniyle önemini sürdürmektedir. Çalışmamızda asendan aorta patolojileri nedeniyle cerrahi uygulanan olgularımızı retrospektif olarak sunmayı amaçladık. Yöntem. Ocak 1997-Kasım 2008 tarihleri arasında, Cumhuriyet Üniversitesi Kalp ve Damar Cerrahisi kliniğince; Asendan aortada anevrizma veya diseksiyon ön tanısıyla opere edilen 65 olguya ait sonuçlar incelenmiştir. Bulgular. Opere edilen 65 olgunun cinsiyet dağılımı 44'ü (%67,69) erkek, 21'i (%32,30) kadın olarak izlendi. Olguların en genci 41 en yaşlısı 82 yaşında olup ortalama yaş erkeklerde 62,45, kadınlarda 64,38 şeklinde izlendi. En sık hastaneye geliş şikâyeti sebebi göğüs ve sırt ağrısı olup ikinci sıklıkta ise nefes darlığıydı. En sık karşılaşılan predispozan faktör hipertansiyon olarak izlendi. Tüm olgularda tanı için torakoabdominal bilgisayarlı tomografi çekildi. Yapılan tetkikler sonucu; Olguların 32'si (%49,23) anevrizma, 29'u (%44,61) tip I diseksiyon, 2'si (%3,07) ise tip II diseksiyon ön tanılarıyla operasyona alındı. Olguların 53'ünde (%81,53) arterial kanül femoral artere kondu. Olguların 6'sında (%9,23) aksillar arter ve 4'ünde (%6,15) brakial arter kanülasyon için kullanıldı. Benthall prosedürü, 19(%29,23) olguya uygulandı. suprakoroner tubüler greft 27(%41,53) olguya, suprakoroner greft ve aort kapak replasmanı 6(%9,23) olguya, bir olguda ise aort kapağına replasman ve anevrizmaya plikasyon, 3 (%4,6) olguda çıkan aort replasmanı ve aort kapak resüspansiyonu, bir olguda çıkan aort replasmanı ve trunkus brakiosefalikusa greft interpozisyonu uygulandı. Perioperatif dönemde 65 olgudan 5(%7,69)'i kaybedildi. İzlem süresi ortalama 17,8±9,7 ay olup izlem süresince ek mortalite izlenmedi. Sonuç. Asendan aort patolojilerinde erken tanı konulması, hızlı ve uygun cerrahi prosedür seçilmesi, postoperatif yeterli süre ve uygun medikasyonla takip edilmesinin morbidite ve mortaliteyi düşüreceği, uzun süreli survey de artış sağlayacağı inancındayız.

Our ascending aortic surgery applications

Aim. Despite significant improvements in surgical techniques, in recent years, importance of serious mortality and morbidity rates is maintaining that due to pathology of ascending aorta. In our study, we aimed to provide that our surgical application due to pathology of ascending aorta retrospectively. Methods. Between January 1997 and November 2008 65 cases were examined that diagnosed and treated by Cumhuriyet University Cardio-Vascular Surgery department in terms of aneurysm or dissection of ascending aorta. Results. Forty four (67.69%) of the cases were man and 21 (32.30%) of the cases were woman. Age ranging between 41 to 82 and main age was 62.45 in men and 64.38 in women. The most common complaint was chest and back pain and shortness of breath was the second in frequency. The most frequently encountered predisposing factor was hypertension. All cases were diagnosed with thoraco-abdominal computed tomography. In a result of examination: 32 of the cases (49.23%) were operated for aneurysm, 29 (44.61%) of the cases were operated for type I dissection and 2 (% 3.07) of the cases were operated for type II dissection. The arterial cannula was placed to femoral artery in 53 (81.53%) of the cases. In 6 (9.23%) of the cases, axillary artery was used for cannulation and in 4 (6.15%) of the cases, brachial artery was used for cannulation. Benthall procedure were applied 19 (29.23%) of the cases. Supracoronary tubular graft was applied to 27 (41.53%) of the cases; Supracoronary graft and aortic valve replacement were applied to 6 (9.23%) of the cases; Aneurysmal plication and aortic valve replacement were applied to one of the cases; Aortic valve resuspension and ascending aortic replacement were applied to 3 (%4.6) of the cases; Graft interposition to truncus brachiocephalicus and ascending aortic replacement were applied to one of the cases. 5 (% 7.69) of 65 cases were died in perioperative period. Average fallow-up period was 17.8±9.7 months and during the follow-up there is no additional mortality. Conclusion. We believe that early diagnosing, selecting of quick and appropriate surgical procedure, appropriate medical application and sufficient postoperative follow-up of ascending aortic pathologies will reduce morbidity and mortality and will also provide an increase in long-term survey.

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