Publication: Tip A aortik diseksiyon cerrahisinde retrograd serebral perfüzyonun retinal mikrosirkülasyona etkileri
Abstract
Amaç: Bu çalışmada aort diseksiyonu ameliyatlarında retrograd serebral perfüzyonun retinal mikrosirkülasyon üzerindeki etkileri araştırıldı. Çalışma planı: Çalışmaya aort diseksiyonu nedeniyle ameliyat edilen 30 hasta alındı. On beş hastaya (grup 1; 12 erkek, 3 kadın; ort. yaş 45±16; dağılım 29-64) sadece çıkan aort replasmanı yapıldı. On beş hastaya (grup 2; 10 erkek, 5 kadın; ort. yaş 49±12; dağılım 33-65) ise çıkan aort replasmanı ile birlikte arkus replasmanı da yapıldı. İntimal yırtık rezeke edilerek, çıkan aort ve arkus aorta kollajen kaplı Dacron greft ile replase edildi. Grup 1’de ilave girişim olarak, dört hastaya etekli teknikle aort kökü replasmanı, bir hastaya koroner arter bypass greftleme yapıldı. Grup 2’de çıkan aort replasmanı ile intimal yırtığın yerine göre dokuz hastada hemiarkus replasmanı, altı hastada total arkus replasmanı uygulandı. Fil hortumu yöntemi 10 hastada kullanıldı. Her iki grupta yer alan hastalara ameliyattan 24-48 saat sonra ve dört hafta sonra gözdibi muayenesi yapıldı. Bulgular: Oküler komplikasyonlar grup 1’de dört hastada, grup 2’de sekiz hastada olmak üzere, 12 hastada görüldü. Dokuz hastada görme bulanıklığı, üç hastada retinal solukluk vardı. Binoküler fotopsi, tümü grup 2’de olmak üzere üç hastada ameliyatın dördüncü haftasından sonra da devam etti. Geçici oküler disfonksiyon sıklığı grup 2’de anlamlı derecede yüksek bulundu (p<0.05). Sonuç: Binoküler iskemik retinopati, aort diseksiyonu cerrahisinde serebral korumanın etkinliğinin bir bulgusu olabilir. Bu nedenle oftalmik muayene, diseksiyon cerrahisinde serebral perfüzyonu izlemede yararlı bir yöntem olabilir.
Background: The aim of this study was to evaluate the influence of retrograde cerebral perfusion on retinal microcirculation in patients operated on for aortic dissections. Methods: Thirty patients underwent surgery for aortic dissections. Of these, 15 patients underwent replacement of the ascending aorta alone (group 1; 12 males, 3 females; mean age 45±16 years; range 29 to 64 years), and 15 patients underwent replacement of the ascending aorta and aortic arch (group 2; 10 males, 5 females; mean age 49±12 years; range 33 to 65 years). The intimal tear was resected and the ascending aorta and aortic arch were replaced with a woven collagenimpregnated Dacron graft. Additional procedures in group 1 included aortic root replacement with the flanged technique in four patients and coronary bypass grafting in one patient. In group 2, nine patients had hemiarcus, six patients had total arcus replacement depending on the location of the intimal tear. The elephant trunk procedure was used in 10 patients. Fundus examinations were performed in the first postoperative 24 to 48 hours and four weeks after the operation. Results: Ocular complications were detected in 12 patients (4 in group 1, and 8 in group 2). Blurred vision was found in nine patients and retinal paleness in three patients. Binocular photopsia persisted in three patients (all in group 2) after four postoperative weeks. The incidence of transient ocular dysfunction was significantly higher in group 2 (p<0.05). Conclusion: Binocular ischemic retinopathy can be a sign of the effectiveness of cerebral protection during aortic dissection surgery. Therefore, ophthalmic examination can be a useful method of observing cerebral perfusion directly during dissection surgery.
Background: The aim of this study was to evaluate the influence of retrograde cerebral perfusion on retinal microcirculation in patients operated on for aortic dissections. Methods: Thirty patients underwent surgery for aortic dissections. Of these, 15 patients underwent replacement of the ascending aorta alone (group 1; 12 males, 3 females; mean age 45±16 years; range 29 to 64 years), and 15 patients underwent replacement of the ascending aorta and aortic arch (group 2; 10 males, 5 females; mean age 49±12 years; range 33 to 65 years). The intimal tear was resected and the ascending aorta and aortic arch were replaced with a woven collagenimpregnated Dacron graft. Additional procedures in group 1 included aortic root replacement with the flanged technique in four patients and coronary bypass grafting in one patient. In group 2, nine patients had hemiarcus, six patients had total arcus replacement depending on the location of the intimal tear. The elephant trunk procedure was used in 10 patients. Fundus examinations were performed in the first postoperative 24 to 48 hours and four weeks after the operation. Results: Ocular complications were detected in 12 patients (4 in group 1, and 8 in group 2). Blurred vision was found in nine patients and retinal paleness in three patients. Binocular photopsia persisted in three patients (all in group 2) after four postoperative weeks. The incidence of transient ocular dysfunction was significantly higher in group 2 (p<0.05). Conclusion: Binocular ischemic retinopathy can be a sign of the effectiveness of cerebral protection during aortic dissection surgery. Therefore, ophthalmic examination can be a useful method of observing cerebral perfusion directly during dissection surgery.