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Ege Journal of Medicine
2019, Cilt 58, Sayı 1, Sayfa(lar) 055-058
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The early outcomes of surgical therapy for chronic type a aortic dissection
Serkan Ertugay1, Anıl Apaydın1, Bora Baysal2
1Ege Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İzmir, Türkiye
2Biruni Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul Türkiye
Keywords: Chronic aortic dissection, aortic replacement, stroke, mortality

Aim: Approximately 10% of acute type A aortic dissections become chronic due to lack of symptoms or non-diagnosis. Clinical course, surgical strategy and outcomes differ. This study aims to analyze early outcomes of surgical treatment for chronic type A aortic dissection.

Materials and Methods: Forty-one patients operated for chronic type A aortic dissection between 2001 and 2014, were included in this study and the data were analyzed retrospectively. Mean age 55.9±13 years and 68% were male. The common risk factors for aortic dissection were hypertension (65%) and coronary artery disease (22%). Thirteen patients (31%) were previously operated for aortic or other cardiac procedure. Surgical incision was median sternotomy in most of patients (95%).

Results: The common procedures were tube graft replacement (20 patients), valved-conduit graft replacement for aortic root (15 patients) and total arch replacement (6 patients). Deep hypothermic circulatory arrest was used in 34 patients and additional antegrad cerebral perfusion in 7 patients, as brain protection strategy. The mean duration of cardiopulmonary bypass, myocardial ischemia time and cerebral ischemia were 210.1±67, 116.3±43 and 27.6±9 min, respectively. The common complications were re-exploration for bleeding in 3 patients, need for prolonged ventilator support in 5 patients. Mean intensive care unit and hospital stay was found 4.1±5 days and 9.8±8 days, respectively. Permanent stroke was observed in one patient because of multiple embolisms. Mortality was observed in one patient (%2) due to embolic stroke.

Conclusion: A low mortality rate can be achieved with appropriate strategy in the surgical treatment of chronic type A aortic dissection. Stroke seems to be the common cause of mortality.


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