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.

BackgroundThe surgical approach for effusive constrictive pericarditis (ECP) has not been extensively studied. We present our institution’s early and long-term results of pericardiectomy in our cohort of patients with ECP.MethodsDiagnosis was made primarily by echocardiography. Right heart catheterisation was performed in eight patients. Pre-operatively, 10 patients had undergone at least one previous attempt at therapeutic pericardiocentesis. Pericardiectomy was performed where appropriate (thickened or inflamed).ResultsOf our 12 patients (50% male, median age 48 years, range 17–72 years), the underlying aetiology included idiopathic in five (41.6%), tuberculosis in four (33%), and malignancy in three patients (25%). Elective surgery was performed in nine patients. Median values of both central venous pressure and pulmonary capillary wedge pressure decreased markedly postoperatively (from 16.5 to 11.0 mmHg, p = 0.02; 20.0–15.0 mmHg, p = 0.01, respectively). There was no in-hospital mortality. Follow up ranged from three months to nine years (median three years). Five (41.6%) patients died during the follow-up period, and cumulative two-year survival was 55.6 ± 1.5%.ConclusionPericardiectomy for ECP was effective, in terms of our early results, in patients unresponsive to medical therapy. Long-term survival depends on the underlying disease.

Autoimmune hemolytic anemia and deficiency of glucose-6-phosphate deyhdrogenase (G6PD) result in severe hemolysis with different mechanisms. In patients with both pathologies, the effects of cardiopulmonary bypass on red blood cells and thrombocytes demand special care before and after open heart surgery. We evaluated the preoperative management and postoperative care of a patient with severe aortic insufficiency associated with G6PD deficiency and autoimmune hemolytic anemia who underwent aortic valve replacement.

Double-valve endocarditis is a serious condition and the surgeon must be aware of the high rates of mortality and morbidity in these patients. Although no association was found, heart blocks and septic embolization must be handled with caution. The patients generally do well after surgery, and recurrences and reoperations decrease by the second year after operation.