Görüntüleme
7
ABSTRACT Objective: Introduction of antegrade (ACP) and retrograde (RCP) cerebral perfusion techniques with deep hypothermic total circulatory arrest (HTCA) significantly decreased neurological complications which are the most important cause of morbidity and early mortality. The cerebral perfusion method is effective on this ratio, as well as factors such as age, presence of co-morbidities, emergency, diameter of the aortic arch and the ascending aorta segment that is replaced. Material and Methods: We have investigated which perfusion method is superior to the other, the determinants of mortality and complication rates according to the groups in order to find the determinants of mortality, and to evaluate the complication rates. The data of 115 patients who were operated for acute, subacute or chronic Stanford Type A dissection and intramural hematoma (IMH) between January 2001 – March 2013 were retrospectively evaluated. Results: No significant differences in CPB, XC, TCA, ACP, total amount of post-operative drainage, requirement of blood products, ventilation time, duration of ICU stay, hospital stay and early mortality rates were found in our evaluation of findings and outcomes of patients in whom we either used the ACP or the RCP technique. In the multivariate analysis determinants of mortality were preoperative presence of hypertension, diabetes mellitus, extremity malperfusion, duration of CPB, and postoperative renal complications. Conclusion: The results of our study and results of others in the medical literature regarding techniques for brain protection in open ascending and aortic arch surgery have suggested that the most effective approach to decrease the neurological complications and to obtain better outcomes may be to decrease the duration of perfusion to the possible extent. Keywords: Aortic Dissection Brain Protection Cerebral Perfusion ÖZET Amaç: Serebral perfüzyon tekniklerinin gelişmesiyle beraber Tip-A disseksiyonların cerrahi tedavisinde önemli iyileşmeler sağlanmıştır. Derin hipotermik total sirkulatuar arrestle beraber antegrad (ASP) ve retrograd serebral perfüzyon (RSP) tekniklerinin kullanılması en önemli morbidite ve erken mortalite nedenlerinden biri olan nörolojik komplikasyonları önemli oranda azaltmıştır. Bununla beraber, ameliyat sonrası geçici (GND) veya kalıcı nörolojik disafonksiyon (KND) insidansı %5,5-33,3 arasında değişmektedir. Bu çalışmada amacımız Tip-A disseksiyon nedeniyle antegrad ve retrograd serebral perfüzyon kullanarak opere ettiğimiz hastaların, operatif ve klinik sonuçlarını karşılaştırmak, mortalite belirleyicilerini saptamak, perfüzyon yöntemlerinin birbirine üstünlüğü olup olmadığını ve komplikasyon oranlarını değerlendirmektir. Gereç ve Yöntemler: Çalışmada Ocak 2001-Mart 2013 tarihleri arasında akut, subakut ve kronik Stanford Tip A disseksiyon ve intramural hematom (IMH) nedeniyle opere edilen, toplam 115 hastanın verileri retrospektif olarak değerlendirildi. Hangi serebral perfüzyon yönteminin daha iyi olduğunu incelemek adına mortalite ve komplikasyon oranlarına etki eden parametreler değerlendirilmeye alındı. Bulgular: KPB, Kros klemp, TCA, ACP, postoperatif drenaj, kan ürünü kullanımı, ventilasyon süresi, YBU yatış süresi, hastane kalış süresi ve erken mortalite oranları arasında ACP ve RCP tekniklerinin kullanımına göre fark saptanmadı. Yapılan univariate analizde ameliyat öncesinde renal bozukluk, ekstremite malperfüzyonu olması, ameliyat sonrası kreatin değerinin 1,5 mg/dl üzerinde olması, inotropik ajan kullanma ihtiyacı, pulmoner komplikasyon, renal komplikasyon, hemodiyaliz ihtiyacı mortalite belirleyicileri olarak saptandı. Sonuç: Sonuç olarak, açık asendan ve arkus aorta cerrahisinde, serebral koruma yöntemi konusunda, çalışmamızın sonuçları ve literatürdeki karşıt sonuçlar birlikte değerlendirildiğinde, her iki teknikte de perfüzyon sürelerinin mümkün olduğunca kısa tutulması, nörolojik komplikasyonların azaltılmasında ve daha iyi sonuçlar alınmasında en etkili yaklaşım olacaktır. Anahtar Kelimeler: Aortik Diseksiyon Beyin Koruma Serebral Perfuzyon
ABSTRACT Objective: Introduction of antegrade (ACP) and retrograde (RCP) cerebral perfusion techniques with deep hypothermic total circulatory arrest (HTCA) significantly decreased neurological complications which are the most important cause of morbidity and early mortality. The cerebral perfusion method is effective on this ratio, as well as factors such as age, presence of co-morbidities, emergency, diameter of the aortic arch and the ascending aorta segment that is replaced. Material and Methods: We have investigated which perfusion method is superior to the other, the determinants of mortality and complication rates according to the groups in order to find the determinants of mortality, and to evaluate the complication rates. The data of 115 patients who were operated for acute, subacute or chronic Stanford Type A dissection and intramural hematoma (IMH) between January 2001 - March 2013 were retrospectively evaluated. Results: No significant differences in CPB, XC, TCA, ACP, total amount of post-operative drainage, requirement of blood products, ventilation time, duration of ICU stay, hospital stay and early mortality rates were found in our evaluation of findings and outcomes of patients in whom we either used the ACP or the RCP technique. In the multivariate analysis determinants of mortality were preoperative presence of hypertension, diabetes mellitus, extremity malperfusion, duration of CPB, and postoperative renal complications. The results of our study and results of others in the medical literature regarding techniques for brain protection in open ascending and aortic arch surgery have suggested that the most effective approach to decrease the neurological complications and to obtain better outcomes may be to decrease the duration of perfusion to the possible extent. Keywords: Aortic Dissection; Brain Protection; Cerebral Perfusion; SPECIAL Purpose: With the development of brain perfusion techniques, significant improvements have been made in the surgical treatment of type-A dissections. The use of antegrad (ASP) and retrograd cerebral perfusion (RSP) techniques, along with deep hypotermic total circulatory arrest, has significantly reduced neurological complications, which are one of the causes of predominant morbidity and early mortality. However, the incidence of postoperative temporary (GND) or permanent neurological dysfunction (KND) ranges between 5.5% and 33.3%. In this study, our goal is to compare the operational and clinical results of patients we operate using antegrad and retrograd brain perfusion due to type-A dissection, identify mortality determiners, assess whether perfusion methods are superior to each other and the rates of complications. In the study, data of a total of 115 patients operated due to acute, subacute and chronic Stanford type A disection and intramural hematoma (IMH) between January 2001 and March 2013 were retrospective. For the purpose of examining which brain perfusion method is better, the parameters affecting mortality and complication rates were taken to be assessed. Results: KPB, Kros clemp, TCA, ACP, postoperative drainage, blood product use, ventilation time, YBU deposit time, hospital stay time and early mortality rates are not determined according to the use of ACP and RCP techniques. In the univariate analysis, a renal disorder, an end malperfusion, a post-operative value of creatine above 1.5 mg/dl, the need for the use of an inotropic agent, pulmonary complications, renal complications, hemodialysis need were identified as mortality determiners. Result: As a result, in the open asendan and arkus aorta surgery, when the brain protection method is evaluated together, the results of our study and the opposite results in literature, both techniques will have a shortest possible retention of perfusion periods, an effective approach in reducing neurological complications and getting better results. Keywords: Aortic Disection; Brain Protection; Brain Perfusion;
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
Makale Detay 
Benzer Makaleler
PDF Görüntüle
Dergi Bilgisi
Eseri Dinleyin
Alıntı Yap
Bu Sayfayı Yazdırın
Paylaş
Mendeley
