Serkan ERTUGAY, Anıl APAYDIN, Bora BAYSAL

Kronik tip a aort diseksiyonunun cerrahi tedavisinde erken dönem sonuçlar

Amaç: Akut tip A aort diseksiyonlarının yaklaşık %10’u, semptomların olmaması veya tanı konulamamasına bağlı olarak kronikleşmektedir. Bu hastalarda klinik gidiş, cerrahi strateji ve sonuçlar farklılıklar göstermektedir. Bu çalışmada amaç kronik tip A aort diseksiyonu nedeniyle opere edilen hastaların erken dönem sonuçlarını analiz etmektir. Gereç ve Yöntem: Çalışmaya 2001-2014 yılları arasında, kronik tip A aort diseksiyonu nedeniyle ameliyat edilen toplam 41 hastanın verileri retrospektif olarak analiz edildi. Bu hastaların 28’ i erkek (%68) ve yaş ortalaması 55,9±13 yıl idi. Hastaların öyküsünde en sık saptanan risk faktörleri hipertansiyon (%65), koroner arter hastalığı (%22) idi. Tüm hastaların 13 tanesinde (%31,7) geçirilmiş aort veya diğer kardiyak cerrahi öyküsü mevcuttu. Cerrahi insizyon olarak hastaların çoğunda (%95) median sternotomi uygulandı. Bulgular: Cerrahi teknik olarak 20 hastaya basit tüp greft replasmanı, 15 hastada aort kökü kondüit greft replasmanı, 6 hastada total arkus replasmanı uygulandı. Beyin koruma stratejisi olarak derin hipotermik sirkülatuar arrest (%82,9), ve antegrad serebral perfüzyon (%17,1) uygulandı. Tüm hastalarda saptanan ortalama kardiyopulmoner by-pass süresi 210,1±67 dk, miyokard iskemi süresi ise 116,3±43 dk olarak saptandı. Ortalama serebral iskemi süresi 27,6±9 dakika olarak bulundu. Postoperatif 3 hastada reeksplorasyon gerektiren kanama, 5 hastada uzamış mekanik ventilatör desteği gerekmiştir. Hastaların ortalama yoğun bakım kalış süresi 4,1±5 gün iken hastanede kalış süresi 9,8±8 gün olarak bulundu. Bir hastada multipl embolilere bağlı kalıcı strok gelişti. Mortalite bir hastada (%2) görülmüş olup bu hastada ölüm nedeni embolik strok olarak kaydedilmiştir. Sonuç: Kronik tip A aort diseksiyonlu hastaların cerrahi tedavisinde düşük mortalite oranı uygun strateji ile sağlanabilir. Strok en önemli mortalite nedeni olarak göze çarpmaktadır.

The early outcomes of surgical therapy for chronic type a aortic dissection

Aim: Approximately 10% of acute type A aortic dissections become chronic due to lack of symptoms or nondiagnosis. Clinical course, surgical strategy and outcomes differ. This study aims to analyze early outcomes of surgical treatment for chronic type A aortic dissection. Materials and Methods: Forty-one patients operated for chronic type A aortic dissection between 2001 and 2014, were included in this study and the data were analyzed retrospectively. Mean age 55.9±13 years and 68% were male. The common risk factors for aortic dissection were hypertension (65%) and coronary artery disease (22%). Thirteen patients (31%) were previously operated for aortic or other cardiac procedure. Surgical incision was median sternotomy in most of patients (95%). Results: The common procedures were tube graft replacement (20 patients), valved-conduit graft replacement for aortic root (15 patients) and total arch replacement (6 patients). Deep hypothermic circulatory arrest was used in 34 patients and additional antegrad cerebral perfusion in 7 patients, as brain protection strategy. The mean duration of cardiopulmonary bypass, myocardial ischemia time and cerebral ischemia were 210.1±67, 116.3±43 and 27.6±9 min, respectively. The common complications were re-exploration for bleeding in 3 patients, need for prolonged ventilator support in 5 patients. Mean intensive care unit and hospital stay was found 4.1±5 days and 9.8±8 days, respectively. Permanent stroke was observed in one patient because of multiple embolisms. Mortality was observed in one patient (%2) due to embolic stroke. Conclusion: A low mortality rate can be achieved with appropriate strategy in the surgical treatment of chronic type A aortic dissection. Stroke seems to be the common cause of mortality.

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