RESUMO
AIM: Prolonged cardio-pulmonary bypass (CPB) time, usually necessary for reoperations, is known to increase mortality in coronary bypass procedures and aortic reoperations. We investigated if prolonged CPB time and arch reconstruction in reoperations of the thoracic aorta affect in-hospital outcome. METHODS: Twenty-nine patients underwent reoperations on the thoracic aorta. The reoperations performed were aortic root replacement with composite graft without aortic arch involvement in ten patients, isolated ascending aorta replacement in six patients, aortic arch replacement as a primary procedure in two patients, and aortic arch in conjunction with ascending or descending aorta replacement in 11 patients. RESULTS: Fourteen patients had aortic reoperation with deep hypothermic circulatory arrest (DHCA) and 15 without DHCA. The in-hospital mortality rate was 13.8%. The use deep hypothermic circulatory arrest or CPB time did not affect early outcome. Previous coronary artery bypass procedure was independent predictor of in-hospital mortality. Seven patients required re-exploration for bleeding. One patient suffered from stroke and finally five patients had prolonged ventilation, two requiring tracheostomy. There have been no deaths in the follow-up period. None of the patients has required repeat surgical intervention on the heart or the aorta. CONCLUSION: The use of DHCA or prolonged CPB time do not affect early outcome in reoperations of the thoracic aorta.
Assuntos
Aorta Torácica/cirurgia , Implante de Prótese Vascular , Ponte Cardiopulmonar , Parada Circulatória Induzida por Hipotermia Profunda , Adulto , Idoso , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/mortalidade , Distribuição de Qui-Quadrado , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Parada Circulatória Induzida por Hipotermia Profunda/mortalidade , Ponte de Artéria Coronária/mortalidade , Grécia , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemAssuntos
Actinomyces/crescimento & desenvolvimento , Actinomicose/patologia , Omento/microbiologia , Doenças Peritoneais/microbiologia , Actinomyces/isolamento & purificação , Actinomicose/diagnóstico , Actinomicose/terapia , Idoso , Feminino , Humanos , Laparotomia , Omento/cirurgia , Penicilina V/uso terapêutico , Penicilinas/uso terapêutico , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/terapiaRESUMO
We describe a unique case of a de novo desmoid tumor of the posterior mediastinum in a 21-year-old nulligravida. The tumor recurred twice despite its histologically confirmed radical extirpations. Because of the aggressive local behavior of desmoid tumors and their unusual locations, which prevent wide excision margins, we favor the early consideration of adjuvant therapy.
