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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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The Journal of Cardiovascular Surgery 2002 Ottobre;43(5):609-15

CARDIAC SECTION 

 ORIGINAL ARTICLES

Selective management of high risk patients with an ascending aortic dilatation during aortic valve replacement

Ogus N. T., Çiçek S., Isik Ö.

Department of Cardiovascular Surgery Maltepe University Faculty of Medicine, Istanbul, Turkey

Backgound. The ascend­ing aor­tic dil­a­ta­tion sec­on­dary to aor­tic ­valve dis­ease ­may be a ­risk ­for rup­ture or dis­sec­tion ­unless it is ­not cor­rect­ed ­with a ­graft replace­ment dur­ing ­valve sur­gery. This addi­tion­al pro­ce­dure ­requires pro­longed oper­a­tion ­time ­that ­can be harm­ful ­for ­the crit­i­cal ­patient. External rein­force­ment of dis­eased aor­ta is an ­old ­but sim­ple meth­od ­with debat­ed ­long ­term ­results, pro­vid­ing ­brief dura­tion ­and low­er com­pli­ca­tion ­rate of ­the aneu­rysm oper­a­tion ­for crit­i­cal­ly ­ill ­patients ­whose ­life expec­tan­cy is ­poor.
Methods. Twenty-­two ­patients under­went aor­tic ­valve replace­ment ­and exter­nal aor­tic wrap­ping pro­ce­dure in ­our clin­ic. All of ­the ­patients ­had ­severe asso­ciat­ed ­risk fac­tors to com­pli­cate ­the clas­si­cal aor­tic ­graft replace­ment pro­ce­dure. In ­this pros­pec­tive clin­i­cal ­study, ­the fol­low-up peri­od of ­the ­patients is 79.91 ­patient-­years.
Results. There ­was no oper­a­tive mor­tal­ity. The aver­age hos­pi­tal ­stay ­was 8.6±2.6 ­days. There ­was no ­late ­death or car­diac mor­bid­ity. All of ­the ­patients ­were in ­NYHA Class 1 at post­op­er­a­tive 3rd ­month ­and there­af­ter. In CT ­scans ­the ­mean pre­op­er­a­tive ascend­ing aor­tic diam­e­ter ­was 5.12±0.38 cm ­while ­the ­mean diam­e­ter at 3rd ­month post­op­er­a­tive­ly ­was 3.19±0.25 cm. The reduc­tion in diam­e­ter ­showed a sig­nif­i­cant dif­fer­ence (p<0.0001). The ­time relat­ed chang­es in lumi­nal diam­e­ters ­showed ­some enlarge­ment with­in ­the ­first ­year of ­the oper­a­tion (p=0.03) ­that ­remained ­the ­same there­af­ter.
Conclusions. The ear­ly ­results ­and 4 ­years fol­low-up sug­gest ­that ­the tech­nique ­can be regard­ed as ­safe ­and effec­tive in select­ed ­high ­risk ­patients.

lingua: Inglese


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