Malperfusion in acute type I aortic dissection

Amaç: Tip l akut aort disseksiyonun önemli bir komplikasyonu olan malperfüzyon karşımıza miyokardiyal, serebral, visserai ve ekstremite iskemisi şeklinde çıkar. Bu çalışmada kliniğimizde malperfüzyon bulguları olan tip l aort disseksiyonlu olgulara yapılan acil cerrahi müdahale, malperfüzyonun dağılımı ve mortalite oranının retrospektif olarak değerlendirilmesi amaçlanmıştır. Materyal ve Metod: Kliniğimizde acil olarak ameliyat edilen 83 akut tip I aort disseksiyonu olgusu içinde 23'ü erkek, 4'ü kadın olan 27 hastada tespit edilen 36 malperfüzyon retrospektif olarak değerlendirildi. Bütün hastalar derin hipotermik sirkulatuvar arrest altında ameliyat edildi. Cerrahi işlem olarak 9 hastada asandan aort ± arkus greft replasmam, 14 hastada asandan aort greft replasmanı ve aort kapak resuspansiyonu, 3 hastada kompozit kapaklı greft ile aort kapak, asandan aort ± arkus replasmanı yapıldı. Bulgular: Bu hastalarda toplam 36 malperfüzyon saptandı. Ekstremite malperfüzyonu sayısı 19, miyokard 6, serebral 7 ve visserai 4 olarak tespit edildi. Tip l akut aort disseksiyonu nedeni ile acil olarak ameliyat edilen hastalarda toplam mortalité oranı %26 olarak bulundu. Malperfüzyon bulunmayan hastalarda mortalité oranı %19 olarak tespit edildi. Malperfüzyonlu hastalarda global mortalité %40.7 iken, 16 olgu (%59.3) takip altındadır. Sonuç: Tip I akut aort disseksiyonunda asandan aort replasmanı ve yalancı tümeni kapatmanın öncelikli tedavi şekli olduğu ve periferik vasküler cerrahi girişimlerin nadir başvurulması gereken cerrahi yöntemler olduğu kanısındayız.Background: Malperfusion, which is an important complication of acute type 1 aortic dissection, appears with myocardial, cerebral, visceral and extremity ischemia. In this study, emergency operation, distributions of malperfusion and mortality rate were studied retrospectively in the patients who have type I aortic dissection with signs of malperfusion. Methods: Twenty-seven patients (23 male and 4 female), who have totally 36 malperfusions, within 83 urgently operated patients for acute type 1 aortic dissection, were studied retrospectively. All of the patients were operated under deep hypothermic circulatory arrest. Ascending aortic with/without arcus graft replacement was performed in 9 patients, ascending aortic graft replacement and aortic valve resuspention was performed in 14 patients, and ascending aorta with/without arcus and aortic valve replacement with a composite graft/and mechanical aortic valve was performed in 3 patients. Results: Thirty-six malperfusions were diagnosed in 27 patients. Number of malperfusion of the extremities was 19, number of malperfusion of the myocardium was 6, number of malperfusion of the cerebrum was 7, and number of malperfusion of the visceral organs was 4. Mortality rate of the patients, who were urgently operated for acute type I aortic dissection, was 26%. Mortality rate of the patients, who did not have any sign of malperfusion appeared, as 19% whereas it was 40.7% for the patients, who had malperfusion signs. Sixteen patients survived (59.3%). Conclusion: We are in the opinion that primary treatment of acute type 1 aortic dissection is ascending aortic replacement and closure of the false lumen, and peripheral vascular surgical intervention should rarely be applied