Anıl ÖZEN, Ümit KERVAN, Zafer İŞCAN, Garip ALTINTAŞ, Ertekin Utku ÜNAL, Selin ÖZEN, Mehmet Ali ÖZATİK, Metin YILMAZ

Factors affecting long-term survival of patients undergoing aortic surgery using the antegrade selective cerebral perfusion technique

Amaç: Bu çalışmada antegrad selektif serebral perfüzyon (ASSP) tekniği ile kliniğimizde ameliyat edilen çıkan ve arkus aort anevrizma tamiri veya aort diseksiyonu yapılan hastalarda uzun dönem sağkalımı etkileyen faktörler araştırıldı.Çalışma planı: Ocak 2000 - Aralık 2008 tarihleri arasında, ASSP tekniği ile kliniğimizde ameliyat edilen 177 hastadan sağ kalan ve hastaneden taburcu edilmiş olan 154 hasta (89 erkek, 65 kadın; ort. yaş 54.5±12.4 yıl; dağılım 20 - 84 yıl) çalışmaya dahil edildi. Seksen dört hastaya (%54.5) diseksiyon ameliyatı ve 70 hastaya (%45.5) anevrizma tamiri yapıldı. Takip sürecinde sağ kalan hastalar grup 1'de, kaybedilen hastalar ise grup 2'de yer aldı.Bul gu lar: Ortalama takip süresi 50.5±26.8 ay idi. Takip sürecinde 10 hasta kaybedildi. Mortalite oranı %6.49 idi. Yoğun bakım kalış süresi (p< 0.05) ve kan ve taze donmuş plazma (TDP) transfüzyon hacmi (p< 0.05 her ikisi için) grup 2'de yüksek idi. Yoğun bakım kalış süresi eşlik eden koroner arter hastalığı (p< 0.05), kanama (p< 0.005) kardiyak tamponad (p< 0.005), uzamış ventilasyon (p< 0.001) ve inotropik destek gereksinimi olan hastalarda (p< 0.001) daha uzundu. İki grup arasında anlamlı farklılık gösteren değişkenler ile yapılan lojistik regresyon analizinde ise, kan transfüzyonunun uzun dönem sağkalım için bağımsız bir öngördürücü olduğu saptandı (OR 1.33, %95 CI; 1.02-1.74, p=0.035). Bir, beş ve on yıllık aktüeryal sağkalım sırasıyla %98, %94.8 ve %93.5 olarak bulundu.So nuç: Uzamış yoğun bakım kalış süresi ve ilişkili risk faktörleri, ASSP tekniği kullanılarak ameliyat edilen hastaların uzun dönem sağkalımlarını etkileyebilir. Uzun süreli sağkalım elde etmek için, bu risk faktörlerinin belirlenmesi ve kontrolü ile birlikte vasküler risk faktörleri de göz önünde bulundurulmalıdır

Antegrad selektif serebral perfüzyon tekniği ile aort cerrahisi yapılan hastalarda uzun dönem sağkalımı etkileyen faktörler

Background: This study aims to investigate the factors effecting long-term survival of patients undergoing ascending and arcus aortic aneurysm repair and/or dissection surgery using the antegrade selective cerebral perfusion (ASCP) technique. Methods: Between January 2000 and December 2008, 154 operative survivors of 177 patients (89 males, 65 females; mean age 54.5±12.4 years; range 20 to 84 years) who were operated in our clinic using the ASCP technique and discharged from the hospital were included in the study. Eighty-four patients (54.5%) underwent dissection repair, while 70 (45.5%) underwent aneurysm repair. Patients who survived during the follow-up period were classified as group 1 and those who died were classified as group 2. Results: The mean follow-up period was 50.5±26.8 months. Ten patients died during the follow-up period. The mortality rate was 6.49%. The length of intensive care unit stay (p< 0.05), and blood and fresh frozen plasma (FFP) transfusion volume (p< 0.05 for both) were higher in group 2. The length of intensive care unit stay was longer in patients with comorbid coronary artery disease (p< 0.05), bleeding, cardiac tamponade (p< 0.005), prolonged ventilation (p< 0.001), and those on inotropic support (p< 0.001). Logistic regression analysis of the variables with significant differences between the two groups revealed that the blood transfusion was an independent predictor for long-term survival (OR 1.33, 95% CI; 1.02-1.74, p=0.035). The probability of actuarial survival was found to be 98%, 94.8% and 93.5% at one, five and ten years, respectively. Conclusion: Prolonged length of intensive care stay along with associated risk factors may affect the long-term survival of the patients operated using the ASCP technique. These risk factors should be established and controlled, while vascular risk factors should also be considered to achieve a long-term survival

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1. Coselli JS, LeMaire SA. Experience with retrograde cerebral perfusion during proximal aortic surgery in 290 patients. J Card Surg 1997;12:322-5.
2. Westaby S, Katsumata T, Vaccari G. Arch and descending aortic aneurysms: influence of perfusion technique on neurological outcome. Eur J Cardiothorac Surg 1999;15:180-5.
3. Bachet J, Guilmet D, Goudot B, Dreyfus GD, Delentdecker P, Brodaty D, et al. Antegrade cerebral perfusion with cold blood: a 13-year experience. Ann Thorac Surg 1999;67:1874-8.
4. Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M. Improved results of atherosclerotic arch aneurysm operations with a refined technique. J Thorac Cardiovasc Surg 2001;121:491-9.
5. Jacobs MJ, de Mol BA, Veldman DJ. Aortic arch and proximal supraaortic arterial repair under continuous antegrade cerebral perfusion and moderate hypothermia. Cardiovasc Surg 2001;9:396-402.
6. Hagl C, Ergin MA, Galla JD, Lansman SL, McCullough JN, Spielvogel D, et al. Neurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg 2001;121:1107-21.
7. Neri E, Massetti M, Capannini G, Carone E, Tucci E, Diciolla F, et al. Axillary artery cannulation in type a aortic dissection operations. J Thorac Cardiovasc Surg 1999;118:324-9.
8. Küçüker SA, Ozatik MA, Saritaş A, Taşdemir O. Arch repair with unilateral antegrade cerebral perfusion. Eur J Cardiothorac Surg 2005;27:638-43.
9. Ozatik MA, Küçüker SA, Tülüce H, Sartiaş A, Sener E, Karakaş S, et al. Neurocognitive functions after aortic arch repair with right brachial artery perfusion. Ann Thorac Surg 2004;78:591-5.
10. Karadeniz U, Erdemli O, Ozatik MA, Yamak B, Demirci A, Küçüker SA, et al. Assessment of cerebral blood flow with transcranial Doppler in right brachial artery perfusion patients. Ann Thorac Surg 2005;79:139-46.
11. Uchida N, Watanabe S, Shinozaki S, Niibori K, Sadahiro M, Ohmi M, et al. Early and late results of replacement of the ascending aorta and/or aortic arch using selective cerebral perfusion. Nihon Kyobu Geka Gakkai Zasshi 1997;45:1076- 83. [Abstract]
12. Kirsch M, Soustelle C, Houël R, Hillion ML, Thébert D, Alimoussa B, et al. Long-term results of surgery for type A acute aortic dissection. Arch Mal Coeur Vaiss 2001;94:1373- 80. [Abstract]
13. Lei Q, Chen L, Jin M, Ji H, Yu Q, Cheng W, et al. Preoperative and intraoperative risk factors for prolonged intensive care unit stay after aortic arch surgery. J Cardiothorac Vasc Anesth 2009;23:789-94.
14. Satdhabudha O, Luengtaviboon K. Surgical management for type A aortic dissection: 38 cases experience in King Chulalongkorn Memorial Hospital: early result and longterm follow-up. J Med Assoc Thai 2002;85 Suppl 1:S156-62.