Mehmet Salih AYDIN, Cengiz MORDENİZ, Deniz DEMİR, Mustafa GÖZ, Cüneyt ŞELLİ, Nihat SÖYLEMEZ

Stanford tip-A akut aort disseksiyonlarında altı olguluk deneyim

Amaç: Bu çalışmada proksimal aort disseksiyonlarındaki altı olguluk deneyimlerimiz değerlendirildi.Çalışma planı: Ağustos 2007-Kasım 2008 tarihleri arasında altı olguya (1 kadın, 5 erkek; ort. yaş 54.2±14.4 yıl; dağılım 36-72 yıl) Stanford tip-A akut aort disseksiyonu nedeniyle cerrahi girişim uygulandı. Olgularda sağ femoral, aortik veya sağ aksiller arter kanülasyonu ve izotermik kan kardiyoplejisi tercih edildi. Distal anastomozlar kros-klemp altında veya açık teknikle teflon şerit destekli olarak yapıldı. Aort kapakta yetmezlik saptanan olgularda aort kökü, doku yapıştırıcısı ve resüspansiyon dikişleri ile desteklenerek tamir edildi.Bulgular: Tanı aracı olarak, olguların beşinde ekokardiyografi ile kontrastlı göğüs tomografisi birlikte, bir olguda ise tek başına kontrastlı göğüs tomografisi tercih edildi. Olguların beşinde asendan aorta tüp greft interpozisyonu, bir olguda asendan aort ile birlikte hemiarkus replasmanı uygulanırken; beş olguda aort yetmezliği nedeniyle aortik resüspansiyon dikişleri kullanıldı. Mortalite %33.3 oldu (n=2).Sonuç: Akut proksimal aort patolojilerinin tedavisinde erken tanı, teflon destekli anastomoz tekniği, resuspansiyon sütürü ile birlikte yapılan aort kökü remodelingi ve aksiller arter kanülasyonu kullanımının güvenli olduğu kanaatindeyiz.

Six-cases experience with Stanford type-A aortic dissection

Background: In this study, we aimed to evaluate our six-case experience in the proximal aortic dissection management.Methods: We operated on six patients (1 female, 5 males; mean age 54.2±14.4 years; range 36 to 72 years) of Stanford type-A aortic dissection between August 2007 and November 2008. Right femoral, aortic or axillary artery canulation and isothermic blood cardioplegia were used. Distal anastomoses were completed by cross-clamp or open technique using reinforcement with teflon felt. In case of an insufficiency in the aortic valve, the aortic root was repaired by applying biological tissue glue and commissural suture resuspension.Results: In five cases, we used both echocardiography and contrast enhanced thoracic computed tomography for diagnosis. In one case, only contrast enhanced thoracic computed tomography was preferred. While in five cases, interposition of tubular graft was used to repair the ascending aorta, in one case, the ascending aorta and hemiarch replacement was performed. In five cases, resuspension sutures were placed due to aortic insufficiency. The mortality rate was 33.3% (n=2).Conclusion: We consider that early diagnosis, the anastomosis reinforced with teflon felt, aortic remodeling together with resuspension suture and axillary artery cannulation are safe applications in the management of acute proximal aortic pathologies.

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