Anıl Ziya APAYDIN, Pelin ÖZTÜRK, Engin KARAKUŞ, Ali Önder KILIÇ, Mustafa ÖZBARAN

Oral antikoagülasyon kullanımının akut tip A aort diseksiyonlarında sahte lümen açıklığı üzerindeki etkisi

Amaç: Bu çalışmada akut tip A aort diseksiyonlu hastalarda, ameliyat sonrası oral antikoagülan kullanımının distal aorttaki sahte lümen açıklığı üzerine etkisi araştırıldı. Çalışma planı: Kliniğimizde akut tip A aort diseksiyonu tanısı konularak ameliyata alınan ve dosya bilgileri, poliklinik kontrolleri ile kontrol bilgisayarlı tomografi kayıtlarına eksiksiz olarak ulaşılabilen 41 hasta (32 erkek, 9 kadın; ort. yaş 56.8±13.6 yıl; dağılım, 30-84 yıl) çalışmaya alındı. Uygulanan cerrahi tipine göre hastalar iki gruba ayrıldı. Hastaların bilgisayarlı tomografi görüntüleri taranarak, sahte lümenin açık kalma oranları değerlendirildi. Oral antikoagülasyon dışında, akut tip A aort diseksiyonuna sekonder olarak gelişen sahte lümen açıklığı üzerine etkili olabilecek ameliyat öncesi, ameliyat sırası ve ameliyat sonrası risk faktörleri araştırıldı ve istatistiksel analizi yapıldı. Bulgular: Yirmi bir hastada (%51.2) eşlik eden hipertansiyon vardı. Hastaların 35’inde (%85.4) ana semptom göğüs ağrısı idi. Grup 1’deki 16 hastaya (%39) mekanik aort kapak replasmanının eşlik ettiği çıkan aort replasmanı (Bentall operasyonu) uygulanırken, Grup 2’deki 25 hastaya (%61) yalnızca çıkan aort replasmanı yapıldı. Ortalama takip süresi 43.9±26.3 (dağılım, 5-120) ay idi. Gruplar arasında ortalama kardiyopulmoner baypas süresi (p=0.035) ve ortalama kros-klemp süresi (p=0.002) dışında tüm ameliyat parametreleri açısından istatistiksel anlamlı fark bulunmadı. Hastaların kontrol kontrastlı tomografik görüntüleri değerlendirildiğinde, sahte lümenin toraks bölgesi için 34 hastada (%82.9), batın bölgesi için ise 33 hastada (%80.5) açık olduğu görüldü. Ameliyat tipine yani dolaylı olarak antikoagülan kullanımına göre ayrıntılı alt grup analizi yapıldığında hem toraks hem de batın bölgeleri için sahte lümen açık kalma oranları, gruplar arasında istatistiksel olarak anlamlı bulunmadı (sırasıyla, p=0.534 ve p=0.922) Sonuç: Akut tip A aort diseksiyonlu hastalarda, ameliyat sonrası oral antikoagülan kullanımının sahte lümen açıklığı üzerine etkisi bulunmadı.

The impact of oral anticoagulation on false lumen patency in acute type A aortic dissections

Background: In this study, the effect of postoperative oral anticoagulation on the false lumen patency of the distal aorta in patients with acute type A aortic dissection was investigated.Methods: Forty-one patients (32 male, 9 female; mean age 56.8±13.6 years; range, 30 to 84 years) who were diagnosed with acute type A aortic dissection and underwent surgical treatment in our clinic, and whose entire data of both control computed tomographic assessments and all postoperative follow-up visits could be accessed were enrolled. The patients were divided into two groups according to the type of surgical intervention that was performed. Computed tomography imaging of the patients were scanned and false lumen patency rates were evaluated. Besides oral anticoagulation, preoperative, intraoperative, and postoperative risk factors that may have affected false lumen patency secondary to acute type A aortic dissection were evaluated and statistically analyzed.Results: Twenty-one patients (51.2%) had concomitant hypertension. Thirty five (85.4%) of the patients had the main symptom of angina. Sixteen patients (39%) in Group 1 underwent ascending aortic replacement combined with aortic valve replacement (Bentall procedure); while 25 patients (61%) in Group 2 underwent isolated ascending aortic replacement. Mean follow-up was 43.9±26.3 (range: 5-120) months. No statistically significant difference was found between the study subgroups in any of the operation parameters except for cardiopulmonary bypass time (p=0.035) and cross-clamp time (p=0.002). Evaluation of the control contrast-enhanced tomographic imaging of the patients showed false lumen patency in the thorax in 34 patients (82.9%) and in the abdominal region in 33 patients (80.5%). When analyzing subgroups according to the type of surgical procedure, or indirectly anticoagulant use, no statistically significant difference was found in false lumen patency prevalence between the thoracic and abdominal groups (p=0.534 and p=0.922).Conclusion: No potential effect of postoperative anticoagulation on false lumen patency was found in cases with acute type A aortic dissection.

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