Aort koarktasyonu cerrahi sonrası tekrar girişim için risk faktörleri: çocukluk çağı aort koarktasyonu hastalarında geriye yönelik araştırma
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Tarih
2018
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Aort koarktasyonu(AoC) nedeniyle cerrahi girişim uygulanmış hastalarda Rekoarktasyon için risk faktörlerini araştırmak Gereç ve Yöntem:Kliniğimizde Ocak- 2005 – Aralık 2017 tarihleri arasında AoC nedeniyle opere edilmiş 100 hastanın verileri retrospektif olarak tarandı. Çalışmaya 18 yaş altı ve AoC nedenile cerrahi tedavi uygulanmış hastalar dahil edildi. Çalışmaya en az dokuz ay süreli takibi olan hastalar dahil edildi. Hastaların verileri tarandıktan sonra vücut ağırlığı, yaş eşlik eden kardiyak ve aort patolojisi gibi demografik faktörler dışında operasyon tekniği, uygulanan ek prosedürler ve iskemi süresinin rekoarktasyon oluşumuna etkisi araştırıldı. Genel hasta sayısı ve eşlik eden kardiyak patolojiler üzerinden mortalite araştırıldı. Bulgular:Çalışmaya alınan hastaların ortalama yaş 134±412(1-2950)gün ortalam vücut ağırlığı 4.6±2.73(1.1-20.9) kg idi. Hastalardan 30 da (%30) İzole AoC , 28(%28)tanesinde Ventriküler Septal defek (VSD) ile beraber AoC, 42 de (%42) Kompleks Kardiyak patolojiyle beraber AoC tanısı olup 47(%47) hastaya Rezeksiyon uç uca anostomoz ,4(%4) hastaya Yama ile aortoplasti, 49(%49) hastaya Rezeksiyon ve Genişletilmiş uç uca anostomoz tekniği kullanılarak cerrahi onarım yapılmıştı. 45 (%45) hastada Arcus hipoplazisi mevcutdu. Hastalardan 36(%36) tanesine yenidoğan dönemde 64 (%64) infant dönemde ,2(%2) hastaya ise infantil dönem sonrası cerrahi tedavi uygulanmıştı. Hastalardan 7 sinin (%7) operasyon sırasındaki vücut ağırlığı 2.5 kg ın altında 30 (%30) tanesi 2.5-3.5 kg arasında 63 ü(%63) 3.5 kg üzerinde idi. Mevcut veriler üzerinden rekoarktasyon risk faktörleri araştırıldığı zaman operasyon sırasında vücut ağırlığı 3 kg altında olan olgular rekoartasyon gelişimi açısından istatistiksel olarak yüksek riskli bulundu (p=0.001). Yaş , eşlik eden kardiyak ve arcus patolojisi , uygulanan operasyon tekniğine göre karşılaştırma yapıldığı zaman istatistiksel olarak anlamlı değerler bulunmasada yüzdesel olarak hesaplandığı zaman belirtilen değerlerin rekoarktasyon için risk faktörü olduğu bulundu. Sırasıyla P değerleri p=0.202, p=0.942, p=0.328 p=0.09. Arcus hipoplazisi olan hastalarada Rezeksiyon ve genişletilmiş uç uca anastomoz tekniğinin daha güvenli olduğu istatistiksel olarak anlamlı bulunmasada yüzdesel olarak anlamlı bulundu. Genel hasta mortalitesi 13(%13) olarak bulundu. Kompleks kardiyak patolojisi olan hastalarda mortalite oranlarının yüksek olduğu istatistiksel olarak anlamlı bulunmasa da yüzdesel olak bu grup hastalarda mortalite oranlarının yüksek olduğu görüldü. Sonuç: Aort koarktasyonu cerrahi tedavisi kabul edilebilir mortalite ve rekoarktasyon oranlarına sahiptir. Hastalarada eşlik eden Arcus hipoplazisi olduğu zaman Rezeksiyon ve genişletilmiş uç uca anostomoz tekniği tercih edilmelidir.
Object: Investigation of risk factors for recoarctation in patients undergoing surgical intervention for aortic coarctation (AoC) Materials and Methods: Data of 100 patients who were operated for AoC between January 2005 and December 2017 were retrospectively reviewed. Patients under 18 years of age who underwent surgical treatment for AoC were included in the study. Patients with follow-up for at least nine months were included in the study.After the data of the patients were screened, other than demographic factors such as body weight, age and accompanying cardiac and aortic pathology, the operation technique, additional procedures and the effect of ischemia duration on recoarctation were investigated. The number of patients and their associated cardiac pathologies were investigated. Results: The mean age of the patients in the study was 134 ± 412 (1-2950) and the mean body weight was 4.6 ± 2.73 (1.1-20.9) kg. 30 patients (30%) Isolated AoC, 28 (28%) patients with Ventricular Septal defecation (VSD) AoC, 42 (42%) Complex Cardiac pathology together with AoC diagnosis of 47 (47%) patients resection end-to-end anostomosis, 4 patients (4%) underwent surgical repair with patch and aortoplasty, 49 (49%) patients with resection and extended end-to-end anostomosis. 45 (45%) patients had Arcus hypoplasia. 36 (36%) of the patients underwent surgical treatment in 64 (64%) infants in the neonatal period and 2 (2%) patients in the infantile period. Of the patients, 7 (7%) had a body weight of 2.5 kg under operation, 30 (30%) of them were over 2.5-3.5 kg, 63 (63%) were over 3.5 kg. When the risk factors of recoarctation were investigated by means of available data, the patients whose body weight was below 3 kg during the operation were found to be statistically higher in terms of development of recoarthing (p = 0.001). The age, concomitant cardiac and arcus pathology were found to be a risk factor for recoarctation when the comparison was made according to the technique of operation, but when the values were not statistically significant. P values of p = 0.202, p =0.942, p = 0.328, p = 0.09, respectively. Resection and extended end-to-end anastomosis technique were found to be safer in patients with arcus hypoplasia, but statistically significant. Overall patient mortality was 13 (13%). Although the mortality rates in patients with complex cardiac pathologies were not statistically significant, the mortality rates were found to be high in this group of patients. Conclusion: Surgical treatment of aortic coarctation has acceptable mortality and recoarctation rates. Resection and extended end-to-end anostomosis technique should be preferred when there is accompanying Arcus hypoplasia in patients.
Object: Investigation of risk factors for recoarctation in patients undergoing surgical intervention for aortic coarctation (AoC) Materials and Methods: Data of 100 patients who were operated for AoC between January 2005 and December 2017 were retrospectively reviewed. Patients under 18 years of age who underwent surgical treatment for AoC were included in the study. Patients with follow-up for at least nine months were included in the study.After the data of the patients were screened, other than demographic factors such as body weight, age and accompanying cardiac and aortic pathology, the operation technique, additional procedures and the effect of ischemia duration on recoarctation were investigated. The number of patients and their associated cardiac pathologies were investigated. Results: The mean age of the patients in the study was 134 ± 412 (1-2950) and the mean body weight was 4.6 ± 2.73 (1.1-20.9) kg. 30 patients (30%) Isolated AoC, 28 (28%) patients with Ventricular Septal defecation (VSD) AoC, 42 (42%) Complex Cardiac pathology together with AoC diagnosis of 47 (47%) patients resection end-to-end anostomosis, 4 patients (4%) underwent surgical repair with patch and aortoplasty, 49 (49%) patients with resection and extended end-to-end anostomosis. 45 (45%) patients had Arcus hypoplasia. 36 (36%) of the patients underwent surgical treatment in 64 (64%) infants in the neonatal period and 2 (2%) patients in the infantile period. Of the patients, 7 (7%) had a body weight of 2.5 kg under operation, 30 (30%) of them were over 2.5-3.5 kg, 63 (63%) were over 3.5 kg. When the risk factors of recoarctation were investigated by means of available data, the patients whose body weight was below 3 kg during the operation were found to be statistically higher in terms of development of recoarthing (p = 0.001). The age, concomitant cardiac and arcus pathology were found to be a risk factor for recoarctation when the comparison was made according to the technique of operation, but when the values were not statistically significant. P values of p = 0.202, p =0.942, p = 0.328, p = 0.09, respectively. Resection and extended end-to-end anastomosis technique were found to be safer in patients with arcus hypoplasia, but statistically significant. Overall patient mortality was 13 (13%). Although the mortality rates in patients with complex cardiac pathologies were not statistically significant, the mortality rates were found to be high in this group of patients. Conclusion: Surgical treatment of aortic coarctation has acceptable mortality and recoarctation rates. Resection and extended end-to-end anostomosis technique should be preferred when there is accompanying Arcus hypoplasia in patients.
Açıklama
Anahtar Kelimeler
Aort Koarktasyonu, Vücut Ağırlığı, Rekoarktasyon, Arcus Hipoplazisi, Operasyon Tekniği, Aortic Coarctation, Body Weight, The Recoarctation, Arcus Hypoplasia, Operation Technique
