RESUMO
INTRODUCTION: The selection of the ideal cannulation site is still one of the major concerns in ascending aortic surgery. In the last decade, many surgeons have chosen to utilize antegrade cerebral perfusion in hypothermic circulatory arrest. In this study, we aimed to evaluate arterial cannulation techniques in patients who underwent root replacement for annuloaortic ectasia. MATERIALS AND METHODS: Between 2005 and 2012, a total of 69 patients with a diagnosis of annuloaortic ectasia underwent aortic root replacement with femoral artery, axillary artery, and direct innominate artery cannulation (IAC). Patients demographic, operative, and postoperative data were collected prospectively and analyzed. RESULTS: A total of 69 patients were investigated. Their ages varied from 13 to 78 (mean age was 54.25 ± 15.69) and 48 patients were male (69.5%). Mean aortic diameter was 5.65 ± 1.58 cm (min: 4.5 cm to max: 7.8 cm) by computerized tomography. The procedures included modified Bentall operation in 61 patients, and Cabrol operation in eight patients. In hospital, the mortality rate was 1.85%, and a 30-day mortality rate was 3.7% in the IAC group and 6.6% in patients who underwent femoral and axillary artery cannulation. Temporary cognitive dysfunction and stroke rate were similar between groups. CONCLUSION: Innominate cannulation is associated with low morbidity and mortality in patients who underwent ascending aorta surgery.
Assuntos
Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Artéria Axilar , Implante de Prótese Vascular/métodos , Cateterismo/métodos , Artéria Femoral , Adulto , Idoso , Aneurisma da Aorta Torácica/mortalidade , Implante de Prótese Vascular/mortalidade , Ponte Cardiopulmonar/métodos , Cateterismo/mortalidade , Circulação Cerebrovascular/fisiologia , Feminino , Parada Cardíaca Induzida , Mortalidade Hospitalar , Humanos , Hipotermia Induzida , Masculino , Pessoa de Meia-Idade , Perfusão/métodos , Estudos ProspectivosRESUMO
A severely calcified aorta carries a high risk of atheroemboli and bleeding for cardiac surgery with an incidence range of 14% to 29%. Various techniques were described avoiding cannulation and clamping of the aorta. Nowadays, the no-touch beating heart technique seems to be the best alternative in patients with calcific aorta. Herein, we present a closed proximal anastomosis technique in this high-risk patient group.
Assuntos
Doenças da Aorta/cirurgia , Calcificação Vascular/cirurgia , Idoso , Anastomose Cirúrgica/métodos , Humanos , Masculino , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
BACKGROUND: The aim of this study was to determine the effects of neonatal thymectomy on the immune system in later life. METHODS AND RESULTS: Immune system tests were performed in 26 children at 1 year of age. Thirteen of them had been operated for transposition of the great arteries and had thymectomy in the same operation in the neonatal period. Thirteen control subjects were normal. Immune system tests including white blood cell count, lymphocyte count, T and B cells subgroups (CD2, CD4, CD5, CD7, CD8, CD16, CD20, CD22, CD56), mitotic reaction to phytohaemagglutinin in lymphocyte culture. White blood cell count and lymphocyte count were performed. In the statistical analysis, Mann-Whitney U and Wilcoxon rank sum W tests were used for both groups. Statistical significance was taken at a value of P < 0.05. There was no significant difference in mean white blood cell count, mean blastic transformation reaction of lymphocytes to phytohaemagglutinin, and CD7, CD4/CD8, CD20, CD22, CD56 ratios between the two groups (P > 0.05). Significant differences in mean lymphocyte number, and CD2, CD4, CD5, CD8, CD16 ratios between the two groups were defined (P < 0.05). CONCLUSIONS: In our study, it was noticed that mainly T lymphocyte subgroups were effected by neonatal thymectomy. Although no infection requiring therapy was seen in the thymectomized patients, we advise to limit total thymectomy as much as possible in neonatal heart operations.
