Adnan AK, Mustafa AKBULUT, Arzu ANTAL DÖNMEZ, Mesut ŞİŞMANOĞLU, Özgür ARSLAN, Serpil TAŞ, Davut ÇEKMECELİOĞLU, Mehmet Altuğ TUNCER

Akut tip A aort diseksiyonu için frozen elephant trunk işleminin erken ve orta dönem sonuçları

Amaç: Bu çalışmada akut tip A aort diseksiyonlu hastalarda rezidüel sahte lümeni çıkarmak ve geç dönem komplikasyonları önlemek için kullandığımız E-vita OPEN PLUS stent grefti ile total torasik aort onarımının erken ve orta dönem sonuçları araştırıldı. Çalışma planı: Çalışmaya Kasım 2013 - Kasım 2017 tarihleri arasında akut tip A aort diseksiyonu nedeniyle frozen elephant trunk stent grefti ile total torasik aort onarımı geçiren 41 hasta (29 erkek, 12 kadın; ort. yaş 51.9±10.4 yıl; dağılım, 30-77 yıl) dahil edildi. Sahte lümen boyutundaki azalma ve tromboz 10. günde ve üçüncü, altıncı ve 12. aylarda tekrarlanan bilgisayarlı tomografi-anjiyografi ile değerlendirildi. Bulgular: Altı hasta (%14.6) hastanede kalış süresinde ve bir hasta (%2.4) takip süresinde kaybedildi. Frozen elephant trunk stent greftin distal ucu inen aortta T6, T7 v e T 8 düzeylerinde sırasıyla 15 (%36.6), 21 (%51.2) ve beş (%12.2) hastada sonlandı. Supra-aortik damarlar 21 hastada (%51.2) ayrı şekilde veya 20 hastada (%48.8) adacık olarak yeniden implante edildi. Geçici paraparezi (spinal kord iskemisi) sadece bir hastada (%(2.4) gözlenirken iki hastada (%4.9) kalıcı nörolojik defisit (inme veya koma) gözlendi. Ortalama takip süresi 26.5±20.5 ay idi. Birinci aydaki bilgisayarlı tomografi-anjiyografi sahte lümenin pulmoner gövde ve diyafragmatik düzeyde sırasıyla %93.9 ve %54.5 oranında tromboze olduğunu gösterdi. Sonuç: Erken dönem sahte lümen trombozunu sağlayarak tek aşamalı frozen elephant trunk tekniği ile akut tip A aort diseksiyonu tedavisinde total arkus onarımının güvenli ve başarılı olduğunu düşünüyoruz.

Early and mid-term results of frozen elephant trunk procedure for acute type A aortic dissection

Background: This study aims to investigate the early andmid-term results of total thoracic aorta repair with E-vita OPENPLUS stent graft, which we used to remove the residual falselumen and prevent late-term complications in patients with acutetype A aortic dissections.Methods: The study included 41 patients (29 males, 12 females;mean age 51.9±10.4 years; range, 30 to 77 years) who underwenttotal thoracic aorta repair with frozen elephant trunk stent graftfor acute type A aortic dissection between November 2013and November 2017. The reduction in false lumen size andthrombosis were evaluated by repeated computed tomographyangiographyon 10th day and third, sixth, and 12th months.Results: Six patients (14.6%) were lost during hospital stayand one patient (2.4%) was lost during the follow-up period.Frozen elephant trunk stent graft’s distal end at descendingaorta ended at T6, T7, and T8 levels in 15 (36.6%), 21 (51.2%),and five (12.2%) patients, respectively. The supra-aortic vesselswere re-implanted separately in 21 (51.2%) or as island in 20(48.8%) patients. Transient paraparesis (spinal cord ischemia)was observed in only one patient (2.4%), while permanentneurologic deficit (stroke or coma) was observed in two patients(4.9%). Mean duration of follow-up was 26.5±20.5 months.Computed tomography-angiography at first month showed thatfalse lumen became thrombosed at rates of 93.9% and 54.5% atpulmonary trunk and diaphragmatic level, respectively.Conclusion: We believe that total arcus repair in acute type Aaortic dissection treatment with single-session frozen elephanttrunk technique by ensuring early false lumen thrombosis is safeand successful.

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