Bu çalışmada akut tip A aort diseksiyonlu hastalarda rezidüel sahte lümeni çıkarmak ve geç dönem komplikasyonları önlemek için kullandığımız E-vita OPEN PLUS stent grefti ile total torasik aort onarımının erken ve orta dönem sonuçları araştırıldı.Ça lış ma pla nı: Çalışmaya Kasım 2013 -Kasım 2017 tarihleri arasında akut tip A aort diseksiyonu nedeniyle frozen elephant trunk stent grefti ile total torasik aort onarımı geçiren 41 hasta (29 erkek, 12 kadın; ort. yaş 51.9±10.4 yıl; dağılım, 30-77 yıl) dahil edildi. Sahte lümen boyutundaki azalma ve tromboz 10. günde ve üçüncü, altıncı ve 12. aylarda tekrarlanan bilgisayarlı tomografi-anjiyografi ile değerlendirildi.Bul gu lar: Altı hasta (%14.6) hastanede kalış süresinde ve bir hasta (%2.4) takip süresinde kaybedildi. Frozen elephant trunk stent greftin distal ucu inen aortta T 6 , T 7 ve T 8 düzeylerinde sırasıyla 15 (%36.6), 21 (%51.2) ve beş (%12.2) hastada sonlandı. Supra-aortik damarlar 21 hastada (%51.2) ayrı şekilde veya 20 hastada (%48.8) adacık olarak yeniden implante edildi. Geçici paraparezi (spinal kord iskemisi) sadece bir hastada (%(2.4) gözlenirken iki hastada (%4.9) kalıcı nörolojik defisit (inme veya koma) gözlendi. Ortalama takip süresi 26.5±20.5 ay idi. Birinci aydaki bilgisayarlı tomografi-anjiyografi sahte lümenin pulmoner gövde ve diyafragmatik düzeyde sırasıyla %93.9 ve %54.5 oranında tromboze olduğunu gösterdi. So nuç:Erken dönem sahte lümen trombozunu sağlayarak tek aşamalı frozen elephant trunk tekniği ile akut tip A aort diseksiyonu tedavisinde total arkus onarımının güvenli ve başarılı olduğunu düşünüyoruz.

Introduction The aim of this study is to compare postoperative outcomes and follow-up of two different modifications facilitating surgical technique of frozen elephant trunk (FET) procedure for complex thoracic aortic diseases - zone 0 (fixation with total arch debranching) and zone 3 (fixation with islet-shape arch repair). Methods From May 2012 to December 2018, data were collected from 139 patients who had been treated with FET procedure for complex thoracic aortic diseases. According to Ishimaru arch map, patients with proximal anastomotic site of hybrid graft at zone 0 and zone 3 were grouped as Group A (n=58, 41.7%) and Group B (n=81, 58.3%), respectively. Mean age of study population was 54.7±11.4 years, and 111 patients were male (79.9%). Results In-hospital mortality was observed in 20 (14.4%) patients (n=12, acute type A aortic dissection, and n=4, previous aortic dissection surgery). There was no significant difference between both groups in terms of in-hospital mortality. Four patients from Group A and three patients from Group B had permanent neurological deficit ( P =0.32). Three patients from both groups had transient spinal cord ischemia ( P =0.334). Although mean total perfusion time was longer in Group A, duration of visceral ischemia, when compared with Group B, was shorter ( P <0.001). Five-year survival rate was 82.8% in Group A and 81.5% in Group B ( P =0.876). Conclusion FET procedure is a feasible repair technique in the treatment of complex aortic diseases, providing satisfactory early results. Because of its advantageous aspects, zone 0 fixation with debranching is the preferred technique in our clinic.

ObjectivePrimary cardiac tumors are rare lesions with different histological type. We reviewed our 17 years of experience in the surgical treatment and clinical results of primary non-myxoma cardiac tumors.MethodsBetween July 2000 and February 2017, 21 patients with primary cardiac tumor were surgically treated in our institution. The tumors were categorized as benign non-myxomas and malignants. Data including the demographic characteristics, details of the tumor histology and grading, cardiac medical and surgical history, surgical procedure of the patients were obtained from the hospital database.ResultsEleven patients were diagnosed with benign non-myxoma tumor (male/female:7/4), ranging in age from 10 days to 74 years (mean age 30.9±26.5 years). Papillary fibroelastoma was the most frequent type (63.6%). There were two early deaths in benign group (all were rhabdomyoma), and mortality rate was 18%. The mean follow-up period was 69.3±58.7 months (range, 3 to 178 months). All survivals in benign group were free of tumor-related symptoms and tumor relapses. Ten patients were diagnosed with malignant tumor (sarcoma/lymphoma:8/2, male/female:3/7), ranging in age from 14 years to 73 years (mean age 44.7±18.9 years). Total resection could be done in only three (30%) patients. The mean follow-up period was 18.7±24.8 months (range, 0-78 months). Six patients died in the first 10 months.ConclusionComplete resection of the cardiac tumors, whenever possible, is the main goal of surgery. Surgical resection of benign cardiac tumors is safe, usually curative and provides excellent long-term prognosis. On the contrary, malignant cardiac tumors still remain highly lethal.

Aim: Nowadays, usage of hybrid techniques in complex aortic diseases, especially in the high risk patient group for conventional surgery, enables us to cope with the challenges posed in major surgery and reduce complications. In this study, we evaluate our early results in patients who underwent Frozen Elephant Trunk procedure using e-Vita Open stent grafts for complex aortic disease.Methodology: A total of 61 patients (mean age 56 ±11.5, 50 patients (81.9%) were male) who underwent E-vita Open Plus repair between January 2013 and October 201, with the diagnosis of either acute / chronic type I aortic dissection, acute / chronic type III aortic dissection, or thoracic aortic aneurysm were analyzed retrospectively. 21 patients (34.4%) had acute / chronic type I aortic dissection, 22 (36.0%) had acute / chronic type III aortic dissection, 11 (18.0%) had thoracic aortic aneurysm and 7 (11.4%) had residual type I aortic dissection.Results: Arterial cannulation sites were right subclavian artery in 57 patients (93.4%), brachiocephalic artery in 2 patients (3.2%) and ascending aorta in 2 patients (3.2%). The mean times for antegrade cerebral perfusion and cardiopulmonary bypass were 80 minutes (range 52-167) and 178 minutes (range 105-350) respectively. First 30-day mortality rate was 7 (11.4%). In terms of neurological deficit, 2 patients (3.2%) had paraplegia, 3 (4.9%) had major stroke/coma and one (1.6%) had right hemiplegia. Patients with paraplegia and hemiplegia recovered completely and were free of any neurological deficits during discharge. Conclusion:Frozen elephant trunk procedure is a good alternative method which makes the techniques of surgical repair more feasible in the treatment of complex aortic diseases and enables us to use the combination of surgery and endovascular techniques to reduce complications.Key words: Aortic dissection, complex repair, frozen elephant trunk, early results Abstract

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