Necip BECİT, Münacettin CEVİZ, Hikmet KOÇAK, Uğur KAYA, Abdurrahim ÇOLAK

Orta derece dilate çıkan aortun wrapping ile cerrahi tedavisi

Amaç: Bu çalışmada çıkan aort dilatasyonunun wrapping tekniği ile tedavisinin erken ve orta dönem sonuçları sunuldu. Çalışma planı: Ocak 2010 - Şubat 2017 tarihleri arasında çıkan aort dilatasyonu nedeniyle wrapping tekniği uygulanan toplam 54 hasta (16 erkek, 38 kadın; ort. yaş: 56.9±12.7 yıl; dağılım 21-77 yıl) retrospektif olarak incelendi. Tüm hastalarda Dacron greftler kullanıldı. Wrapping, tüm hastalarda diğer kardiyak cerrahi işlemler ile birlikte uygulandı. Wrapping 32 hastada aortoplasti ile birlikte, 22 hastada ise izole olarak yapıldı. Ameliyat öncesi klinik bulgular, eşlik eden kardiyak sorunlar, ameliyat sırası parametreler, ameliyat sonrası erken ve uzun dönem sonuçları değerlendirildi. Çıkan aort ve inen aort çapları, ejeksiyon fraksiyonu, sol ventrikül diyastol sonu ve sistol sonu çapları, cerrahi sonrası bilgisayarlı tomografi veya transtorasik ekokardiyografi kullanılarak ölçüldü ve ameliyat sonrası değerler ile karşılaştırıldı. Bulgular: Ortalama takip süresi 3.8 (dağılım 1-7) yıl idi. Hastaların hiçbirinde wrapping işlemi ile ilişkili ameliyat sırası komplikasyon gözlenmedi. Bir hasta ameliyat sonrası erken dönemde kaybedildi. Bir hastada ise, ameliyat sonrası serebral infarkt, relapssız intraarteriyel fibrinolizis ile sekelsiz olarak düzeltildi. İki hastada kanama nedeni ile diğer iki hastada ise sternal dehisens nedeniyle revizyon gerekti. Ameliyat sonrası aort çaplarında küçülme ve ejeksiyon fraksiyonunda artış istatistiksel olarak anlamlı idi. Takip sırasında sinüs Valsalva ve distal aort dilatasyonu, rüptür, pseudoanevrizma ve greft mobilizasyonu gibi bulgulara rastlanmadı. Sonuç: Çalışma sonuçlarımız, çıkan aort replasmanı gerektirmeyen orta derece aort dilatasyonu olan hastalarda wrapping tekniğinin güvenli bir şekilde uygulanabileceğini göstermektedir.

Surgical treatment with wrapping of the moderately-dilated ascending aorta

Background: The aim of this study is to present early and mid results associated with the treatment of dilatation of the ascending aorta using the wrapping technique.Methods: A total of 54 patients (16 males, 38 females; mean age 56.9±12.7 years; range 21 to 77 years) who were subjected to the wrapping technique due to dilatation of the ascending aorta between January 2010 and Fabruary 2017 were retrospectively analyzed. The Dacron grafts were used in all patients. Wrapping was performed in all patients in combination with the other cardiac surgical procedures. Wrapping was performed with aortoplasty in 32 patients and as an isolated procedure in 22 patients. Preoperative clinical findings, concomitant cardiac procedures, intraoperative parameters, postoperative early and long-term outcomes were evaluated. The ascending aorta and descending aorta diameters, ejection fraction, left ventricle end-diastolic and end-systolic diameters were measured using a computed tomography scan and/or transthoracic echocardiography after surgery, and was compared with the preoperative values.Results: The median follow-up was 3.8 (range, 1 to 7) years. No intraoperative complication associated with the wrapping procedure was reported in any of the patients. One patient died during the early postoperative period. Relapse -free intra-arterial fibrinolysis was used to correct postoperative cerebral infarct in one patient without any sequelae. Revision surgery was required in two patients due to bleeding and in another two patients due to sternal dehiscence. A postoperative decrease in the aortic diameter and an increase in the ejection fraction were found to be statistically significant. Findings such as sinus of Valsalva and distal aortic dilation, rupture, pseudoaneurysm, and graft mobilization were not observed during follow-up.Conclusion: Our study results show that the wrapping techniques may be safely performed in patients with moderate dilatation of the aorta who do not require replacement of the ascending aorta.

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