Mesut ENGİN, MEHMET TUĞRUL GÖNCÜ, Orhan GÜVENÇ, Muhammed SAVRAN, AHMET FATİH ÖZYAZICIOĞLU

Tip A Aort Diseksiyonlarında Operasyon Sonrası Erken Dönem Mortalite ve Morbidite Üzerine Etki Eden Faktörlerin Retrospektif İncelenmesi

Amaç: Aortik diseksiyon günümüzde hala önemli bir mortalite ve morbidite nedenidir. Tip A aort diseksiyonu nedeniyle ameliyat edilen hastalarda birçok faktör cerrahi sonuçları etkilemektedir. Bu faktörlerin yeterince belirlenmesi tedavinin başarılı olmasına etki edecektir. Yöntemler: Kliniğimizde Ocak 2006 - Aralık 2016 yılları arasında Tip A aort diseksiyonu tanısı ile opere edilen 140 hastanın preoperatif, intraoperatif, ve postoperatif verileri, hasta dosyaları ve hastane bilgi yönetim sistem kayıtlarından retrospektif olarak araştırıldı. Gruplar arası niceliksel parametreler Student t veya Mann-Whitney U testleri ile, niteliksel veriler ise Ki-Kare testi ile karşılaştırıldı. Bulgular: Hastalarda ortalama yaş 57.1±12.3 (min: 27 ile max: 84), 31’i (%22,2) kadın, 109’u (%77,8) erkekti. Hastaların çoğunluğuna izole asendan aorta replasmanı veya asendan aorta ile birlikte hemiarkus replasmanı uygulandı (%70). Beyin koruma yöntemi olarak çoğunlukla antegrad serebral perfüzyon (ASP) nadiren retrograd serebral perfüzyon (RSP) kullanıldı. Tüm hastalarda total mortalite 37 kişi (%26,4) idi. Başvuru anında sistolik tansiyonun 90 mmHg altında olması, majör nörolojik defisit varlığı, hastada geçirilmiş kardiyak cerrahi öyküsü olmasının mortaliteyi anlamlı oranda etkilediği saptanmıştır (p

Retrospective Investigation Of Factors Affecting Early Period Mortality And Morbidity After Operation In Type A Aortic Dissections

Aim: Aortic dissection is still an important cause of both mortality and morbidity. Many factors affect surgical outcomes in patients operated for type A aortic dissection. Sufficient identification of these factors will affect the success of the treatment. Methods: Preoperative, intraoperative, and postoperative data of 140 patients who were diagnosed with type A aortic dissection between January 2006 and December 2016 were retrospectively reviewed from patient records and hospital information management system records. Quantative parameters between groups were compared with Student t or Mann-Whitney U tests, and qualitative data were compared with Chi-square test. Results: The mean age of the patients who comprised 31 (22.2%) female and 109 (77.8%) male was 57.1 ± 12.3 (min: 27 to max: 84). The majority of patients underwent isolated ascending aorta replacement or hemiarchus replacement with ascending aorta (%70). Antegrade cerebral perfusion (ACP) and rarely retrograde cerebral perfusion (RCP) were used as the brain preservation method. Total mortality in all patients was 37 (26.4%). The systolic pressure that was below 90 mmHg at the time of admission, the presence of major neurological deficits and past cardiac surgical history had a significant impact on mortality (p

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Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. TheTask Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35(41): 2873-926.
Dake MD, Kato N, Mitchell RS, et al. Endovascular stent graft placement for the treatment of acute aortic dissection. N Engl J Med 1999; 340:1546-52.
Stein E, Mueller GC, Sundaram B. Thoracic aorta (multidetector computed tomography and magnetic resonance evaluation). Radiol Clin North Am 2014; 52: 195-217.
Di Eusanio M, Trimarchi S, Patel HJ, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg 2013;145: 385–390.
Cabasa A, Pochettino A. Surgical management and outcomes of type A dissection—the Mayo Clinic experience. Ann Cardiothorac Surg 2016;5:296-309.
Antonio L, Francesca N, Emanuele B, et al. Total Archversus Hemiarch Replacement forType A Acute Aortic Dissection: A Single-Center Experience. Tex Heart Inst J 2016; 43:488-95.
Kıralı K, Ardal H, Güler M, ve ark. Aort disseksiyonu tedavisinde Fil hortumu prosedürünün kullanımı ve klinik sonuçları. TurkGogus Kalp Dama 2000;8(4);760- 766.
Rylski B, Milewski RK, Bavaria JE, et al. Long-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection. J Thorac Cardiovasc Surg. 2014;148:2981-6.
Christian D, vonAspern K, Silva JR, et al. Impact of Perfusion Strategy on Outcome After Repair for AcuteType A Aortic Dissection. Ann Thorac Surg 2014; 97:78-85.
Trimarchi S, Nienaber CA, Rampoldi V, et al. International Registry of Acute Aortic Dissection investigators; Contemporary results of surgery in acute type A aortic dissection. The International Registry of Acute Aortic Dissection experience. J Thorac Surg. 2005; 129(1):112-22.
Apaydın AZ, Buket S, Posacıoğlu H, et al. Perioperative risk factors for mortality in patients with acute type A aortic dissections. Ann Thorac Surg 2002; 74:2034-9.
Rajendra HM, Toru S, Peter G, et al. Predicting Death in Patients with Acute Type A Aortic Dissection. Circulation. 2002; 105: 200-206.
Nakajima N. Watanabe H, Uemura S, et al. Simultaneous graft replacement of ascending aorta and aortic arch for acute type A dissection have better 67 prognosis. Aortic Surgery Symposium VI. April 30 May 1, 1998, New York, USA.
Crawford ES, Kirklin JW, Naftel DC, et al. Surgery for acute dissection of ascending aorta: should the arch be included? J Thorac Cardiovasc Surg 1992; 104: 46-59.
Galvin SD, Perera NK, Matalanis G. Surgical management of acute type A aortic dissection: branchfirst arch replacement with total aortic repair. Ann Cardiothorac Surg. 2016;5: 236-44.