ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
MALPERFUSION IN ACUTE TYPE I AORTIC DISSECTION
*Ömer Tetik, Yüksel Atay, Tanzer Çalkavur, Tahir Yağdı, Anıl Ziya Apaydın, Hakan Posacıoğlu, Fatih İslamoğlu, Suat Buket
Ege Üniversitesi Tıp Fakültesi, Kalp Damar Cerrahisi Ana Bilim Dalı, İzmir
*Atatürk Eğitim ve Araştırma Hastanesi, Kalp Damar Cerrahisi Kliniği, İzmir
Background: Malperfusion, which is an important complication of acute type I aortic dissection, appears with myocardial, cerebral, visceral and extremity ischemia. In this study, emergency operation, distributions of malperfusion and mortality rate were studied retrospectively in the patients who have type I aortic dissection with signs of malperfusion.

Methods: Twenty-seven patients (23 male and 4 female), who have totally 36 malperfusions, within 83 urgently operated patients for acute type 1 aortic dissection, were studied retrospectively. All of the patients were operated under deep hypothermic circulatory arrest. Ascending aortic with/without arcus graft replacement was performed in 9 patients, ascending aortic graft replacement and aortic valve resuspention was performed in 14 patients, and ascending aorta with/without arcus and aortic valve replacement with a composite graft/and mechanical aortic valve was performed in 3 patients.

Results: Thirty-six malperfusions were diagnosed in 27 patients. Number of malperfusion of the extremities was 19, number of malperfusion of the myocardium was 6, number of malperfusion of the cerebrum was 7, and number of malperfusion of the visceral organs was 4. Mortality rate of the patients, who were urgently operated for acute type I aortic dissection, was 26%. Mortality rate of the patients, who did not have any sign of malperfusion appeared, as 19% whereas it was 40.7% for the patients, who had malperfusion signs. Sixteen patients survived (59.3%).

Conclusion: We are in the opinion that primary treatment of acute type 1 aortic dissection is ascending aortic replacement and closure of the false lumen, and peripheral vascular surgical intervention should rarely be applied.

Keywords : Malperfusion, aortic dissection, circulatory arrest, false lumen
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