İlhan GÖLBAŞI, Atalay METE, İsa AK, Ömer BAYEZİD, Ercan AKBULUT, Harun GÜLMEZ, Cengiz TÜRKAY

Stanford tip A akut aort disseksiyonlarında cerrahi

Tip A disseksiyonlarda cerrahi tedavi uygulanmadığı zaman prognoz oldukça kötüdür. Kliniğimizde 1993-1999 arasında, Tip A aort disseksiyonu nedeniyle 17 hastaya cerrahi tedavi uygulandı. Operasyon femoral arter ve sağ atriyal kanülasyon ile kardiyopulmoner bypass altında gerçekleştirildi. Aort disseksiyonundaki cerrahi yaklaşımımız, intimal yırtık bulunan segmentin rezeksiyonunu takiben tubuler greft replasmanıdır. 12 hasta (%7) taburcu edildi ve beş hasta (%29) erken dönemde kaybedildi, geç dönemde mortalite olmadı.

Surgery in Stanford type A acute aortic dissection

Type A dissection is known to be associated with a particularly poor prognosis without surgical intervention. Surgical treatment for acute type A aortic dissection was performed between 1993-1999 in 17 patients in our clinic. Operations were performed under cardiopulmonary bypass with femoral artery and right atrial cannulation. Our surgical technique for the treatment of aortic dissection is a tubular graft replacement following a resection of the segment of aorta containing the intimal tear. 12 (7%) patients were discharged from hospital, early mortality was 29% (five patients), and there were no late mortality.

PDF

___

1.DeBakey ME, Cooley DA, Creech OJ. Surgicalconsiderations of dissecting aneurysm of the aorta. Ann Surg 1955;142:586-612.
2.Erlich M, Grabenwoger M, Simon P, et al. Surgicaltreatment of type A aortic dissections. Result with profound hypothermia and circulatory arrest. Tex Heart Inst J1995;22:250-4.
3.Weber M, Kerber S, Rahmel A, et al. Acute thoraortic dissection with occlusion of the left coronary artery.Herz 1997;22:104-10.
4.Cambria RP, Brewster DC, Gertler J. Vascularcomplications associated with spontaneous aorticdissection. J Vasc Surg 1988;7:199-209.
5.Svensson L G, Crawford ES. Cardiovascular and VascularDisease of the Aorta. Philadelphia: WB SaundersCompany 1997:42-83.
6.Fuster V, John HI. Medical aspectes of acute aorticdissections. Seminars Thoracic Cardiovasc Surg 1992;3:219-25.
7.Kirklin JW, Brian G. Cardiac Surgery: New York, Churchill Livingstone 1993:1721-48.
8.Hashimoto S, Kumada NC, Osakada G. Assessment of transesophageal Doppler echocardiography in dissecting aortic aneursym. J Am Coll Cardiol 1989;14:1253-62.
9.Nienaber CA, Kodolitsch V, Nicolas V. The diagnosis of thoracic aortic dissection by noninvasive imagingprocedures. N Eng J Med 1993;328:1-9.
10.Crawford ES, Svenson LG, Coselli JS. Aortic dissection and dissecting aortic aneurysms. Ann Surg 1988;208:254-73.
11.Buket S, Apaydýn A, Hamulu A, Özbaran M. Akut aortdisseksiyonlarýnda cerrahi tedavi. Türk Gögüs Kalp DamarCer Derg 1995;3:147-52.
12.Niederhauser U, Rüdiger H, Künzli AVR, et al. Surgery foracute type A aortic dissection: Comparison of techniques.Eur J Cardiothorac Surg 2000;18:307-12.
13.Yamaguchi T, Guthaner DF, Wexler L. Natural history ofthe false channel of type A aortic dissection after surgical repair: CT study. Radiology 1989;170:43-7.
14.Turley K, Ullyot DJ, Godwin JD. Repair of dissection ofthe thoracic aorta: Evaluation of false lumen utilizing computed tomography. J Thorac Cardiovasc Surg 1981;81:61-8.
15.Bilgen F, Alhan C, Yapýcý F, Þiþman M. Akut tip A aortdisseksiyonu tamiri sonrasý distal false lümenin önemi.H. Kardiyoloji ve Kardiyo-Vasküler Cerrahi Bülteni 1997;5:59-62.
16.David TE, Armstrong S, Ivanov J, et al. Surgery for acutetype A aortic dissection. Ann Thorac Surg 1999;67:1999-2001.
17.Mazzucotelli JP, Deleuze PH, Baufreton C. Preservation ofthe aortic valve in acute aortic dissection: Long term echocardiographic assessment and clinical outcome. Ann Thorac Surg 1993;55:1513-7.
18.Fann JI, Glower DD, Miller DC. Preservation of theaortic valve in type A aortic dissection complicated byaortic regurgitation. J Thorac Cardiovasc Surg 1991;102:62-75.
19.Pessotto R, Santini F, Pugliese P. Preservation of theaortic valve in acute type A dissection complicated byaortic regurgitation. Ann Thorac Surg 1999;67:2010-3.
20.Niederhauser U, Rudiger H, Vogt P, et al. Composite graft replacement of the aortic root in acute dissection. Eur J Cardiothorac Surg 1998;13:144-50.
21.Slonim SM, Miller DC, Mitchell RS, Semba CP.Percutaneous balloon fenestration and stenting for life threatening ischemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg 1999;117:1118-27.
22.Fann JI, Sarris GE, Mitchell RS. Treatment of patients withaortic dissection presenting with vascular complications. Ann Surg 1990;212:705-13
23.Pego- Fernandes PM, Stolf NA, Hervoso CM, et al.Management of aortic dissection that involves the right coronary artery. Cardiovasc Surg 1999;7:545-8.
24.Khan R, Amaram S, Gomes JA, et al. Myocardial infarc-tion following acute aortic dissection. Cathet CardiovascDiagn 1980;6:181-4.
25.Svensson LG. How to obtain hemostasis after aortic surgery. Ann Thorac Surg 1999;67:1981-2.
26.Westaby S. Anti-fibrinolytic therapy in thoracic aortic surgery. Ann Thorac Surg 1999;67:1983-5.
27.Rousou JA, Engelman RM, Breyer RH. fibrin glue: An effective hemostaticgent for nonsuturable intraoperative bleeding. Ann Thorac Surg 1984;38:409-10.
28.Sundt TM, Saffitz JE, Stahl DJ. Renal dysfunction and intravascular coagulation after use of aprotinin in thoracicaortic operation employing hypothermic circulatory arrest.Ann Thorac Surg 1993;55:1418-24.
29.Büket S, Alayunt A, Diþcigil B, Apaydýn A. Continiousretrograde cerebral perfusion supplies substrates for brain metabolism during hypothermic circulatory arrest.Perfusion 1995;10:237-44.
30.Bavaria JE, Pochettino A. Retrograde cerebral perfusion (RCP) in aortic arch surgery: Efficacy and possiblemechanisms of brain protection. Seminars Thoracic andCardiovasc Surg 1997;9:222-32.