Fuat BİLGEN, İ. Oral HASTAOĞLU, Fikret YAPICI, Onur SOKULLU, M.Sinan KUT, Bayer ÇINAR, Soner SANİOĞLU, Hayati DENİZ

Torasik aort replasmanlarında erken dönem sonuçlar

Amaç: Torasik aort replasmanlarında mortalite ve morbidite oranları yüksektir. Bu çalışmada inen aort replasmanlarının erken dönem sonuçları ve bu sonuçlara etki eden faktörler incelendi.Çalışma planı: Çalışmaya inen torasik aort replasmanı uygulanan ardışık 28 hasta (24 erkek, 4 kadın; ort. yaş 55±13; dağılım 23-76) alındı. Altta yatan patoloji 12 hastada (%42.9) akut tip B aort diseksiyonu, 11 hastada (%39.3) dejeneratif anevrizma, üç hastada (%10.7) disekan anevrizma, iki hastada (%7.1) aortik transseksiyondu. On dokuz hasta (%67.9) acil, dokuz hasta (%32.1) elektif olarak ameliyat edildi. Acil ameliyat endikasyonları 12 hastada (%63.1) yırtılma, üçünde (%15.8) dirençli ağrı, ikisinde (%10.5) malperfüzyon, ikisinde ise aortik transseksiyondu. On sekiz hastada (%64.3) sol atriyofemoral bypass, 10 hastada (%35.7) basit klempaj tekniği uygulandı. Beyin omurilik sıvısı (BOS) drenajına dokuz hastada (%32.1) başvuruldu. Bulgular: Hastaların ortalama hastanede kalış süresi 16±9 gün bulundu. Hastane mortalitesi dört olguda (%14.3) görüldü. Sağkalan 24 hastanın üçünde (%12.5) uzamış mekanik ventilasyon, üçünde yara yeri enfeksiyonu, ikisinde (%8.3) pnömoni, birer hastada (%4.2) gastrointestinal sistem kanaması, ses kısıklığı, uzamış hava kaçağı, atriyal fibrilasyon görüldü. Yara yeri enfeksiyonu gelişen hastaların sadece birinde revizyona gerek duyuldu. Üç hastada (%10.7) parapleji/ paraparezi görüldü. Bunların ikisinde basit klempaj, birinde sol atriyofemoral bypass tekniği uygulanmış, birinde de beyin omurilik sıvısı drenajı yapılmıştı. Ameliyat değişkenleri ile mortalite ve morbidite arasında anlamlı ilişki saptanmadı. Ancak, BOS drenajı uygulanmayan olgularda, istatistiksel olarak anlamlı olmasa da, daha yüksek oranda paraplejiye rastlandı. Sonuç: Mortalite ve morbiditeye etkisi istatistiksel olarak anlamlı bulunmamış olsa da, sol atriyofemoral bypass ve BOS drenajının inen torasik aort replasmanı sonuçlarını olumlu etkilediğini düşünüyoruz.

Early results of thoracic aorta replacement

Background: Replacement of the thoracic aorta is associated with high mortality and morbidity rates. We evaluated early results of descending aortic replacement and the factors affecting these results.Methods: The study included 28 consecutive patients (24 males, 4 females; mean age 55±13 years; range 23 to 76 years) who underwent descending thoracic aortic replacement. The underlying pathologies were acute type B dissection (n=12, 42.9%), degenerative aneurysm (n=11, 39.3%), dissecting aneurysm (n=3, 10.7%), and aortic transsection (n=2, 7.1%). Nineteen patients (67.9%) underwent emergency surgery, while nine patients (32.1%) were operated on electively. Indications for emergent operation were rupture (n=12, 63.1%), persistent pain (n=3, 15.8%), malperfusion (n=2, 10.5%), and aortic transsection (n=2). Left atriofemoral bypass was used in 18 patients (64.3%), and simple aortic clamping was used in 10 patients (35.7%). Cerebrospinal fluid drainage was performed in nine patients (32.1%). Results: The mean length of hospital stay was 16±9 days. In-hospital mortality occurred in four patients (14.3%). Complications in the remaining patients were prolonged mechanical ventilation (n=3, 12.5%), wound site infection (n=3), pneumonia (n=2, 8.3%), and individually, gastrointestinal system hemorrhage, hoarseness, prolonged air leak, and atrial fibrillation. Revision was required in only one patient with wound site infection. Paraplegia or paraesthesia was detected in three patients (10.7%), of which two were operated on with simple aortic clamping, one with left atriofemoral bypass, and one with cerebrospinal fluid drainage. No significant correlation was found between operative variables and mortality or morbidity. It was noted that, albeit insignificant, the frequency of paraplegia was higher in the absence of cerebrospinal fluid drainage. Conclusion: Based on our experience, left atriofemoral bypass and cerebrospinal fluid drainage have somewhat favorable effects on mortality and morbidity even though this observation was not favored by statistical strength.

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