Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes

Background: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. Aim: To communicate our experience in the first 23 total or partial replacements of aortic arch. Material and methods: Retrospective search in the dat...

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Autores principales:	Irarrázaval Ll,Manuel J, Morán V,Sergio, Zalaquett S,Ricardo, Becker R,Pedro, Baeza P,Cristian, Urzúa U,Jorge, Lema F,Guillermo, Canessa B,Roberto, Chamorro S,Gastón, Braun J,Sandra, Córdova A,Samuel, Garayar P,Bernardita
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2006
Materias:	Aorta, thoracic Aortic aneurysm, thoracic Hipothermia Perfusion
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000500005
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spelling	oai:scielo:S0034-988720060005000052006-06-22Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientesIrarrázaval Ll,Manuel JMorán V,SergioZalaquett S,RicardoBecker R,PedroBaeza P,CristianUrzúa U,JorgeLema F,GuillermoCanessa B,RobertoChamorro S,GastónBraun J,SandraCórdova A,SamuelGarayar P,Bernardita Aorta, thoracic Aortic aneurysm, thoracic Hipothermia Perfusion Background: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. Aim: To communicate our experience in the first 23 total or partial replacements of aortic arch. Material and methods: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. Results: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. Conclusions: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative riskinfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.134 n.5 20062006-05-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000500005es10.4067/S0034-98872006000500005
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Aorta, thoracic Aortic aneurysm, thoracic Hipothermia Perfusion
spellingShingle	Aorta, thoracic Aortic aneurysm, thoracic Hipothermia Perfusion Irarrázaval Ll,Manuel J Morán V,Sergio Zalaquett S,Ricardo Becker R,Pedro Baeza P,Cristian Urzúa U,Jorge Lema F,Guillermo Canessa B,Roberto Chamorro S,Gastón Braun J,Sandra Córdova A,Samuel Garayar P,Bernardita Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes
description	Background: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. Aim: To communicate our experience in the first 23 total or partial replacements of aortic arch. Material and methods: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. Results: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. Conclusions: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk
author	Irarrázaval Ll,Manuel J Morán V,Sergio Zalaquett S,Ricardo Becker R,Pedro Baeza P,Cristian Urzúa U,Jorge Lema F,Guillermo Canessa B,Roberto Chamorro S,Gastón Braun J,Sandra Córdova A,Samuel Garayar P,Bernardita
author_facet	Irarrázaval Ll,Manuel J Morán V,Sergio Zalaquett S,Ricardo Becker R,Pedro Baeza P,Cristian Urzúa U,Jorge Lema F,Guillermo Canessa B,Roberto Chamorro S,Gastón Braun J,Sandra Córdova A,Samuel Garayar P,Bernardita
author_sort	Irarrázaval Ll,Manuel J
title	Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes
title_short	Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes
title_full	Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes
title_fullStr	Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes
title_full_unstemmed	Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes
title_sort	reemplazo parcial o total del arco aórtico: experiencia en 23 pacientes
publisher	Sociedad Médica de Santiago
publishDate	2006
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000500005
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Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes

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