ABSTRACT
BACKGROUND: Acute Type A aortic dissection (AAAD) is a surgical emergency. In patients with arch and descending aorta involvement (DeBakey Type I), a total aortic arch replacement with frozen elephant trunk (FET) could favor false lumen thrombosis and improve long-term results. The authors hereby present their experience with this technique in a single low-volume center, to assess whether the technique is feasible to treat such disease. METHODS: From January 2011 to December 2016, 43 patients with AAAD were operated on in the authors' institution, which carries out 300 to 350 annual procedures. Among these, 12 patients with an intimal tear in the aortic arch and/or proximal descending aorta received a FET procedure (10 males, age 57 years). Concomitant procedures were aortic valve replacement (42%), Bentall (25%), and aortic valve repair (17%). RESULTS: Cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 235 ± 43, 171 ± 33, and 75 ± 20 minutes, respectively. The operative mortality was 16.7% (n = 2). Stroke and re-thoracotomy for bleeding occurred in 8% (n = 1) and 8% (n = 1), respectively. There was no spinal cord injury. Follow-up was 36.1 months. During follow-up, no patients died or required a reoperation on the downstream aorta. CONCLUSION: Although all patients were operated on in a low-volume center, the results with FET in AAAD are acceptable. Even though this technique demands high technical skills, it is a promising approach in patients with acute aortic dissection.
ABSTRACT
Introducción. La dehiscencia esternal es una complicación relativamente frecuente de la esternotomía media y que causa gran morbimortalidad en cirugía cardiotorácica. La obesidad se considera uno de los factores de riesgo más importantes de dehiscencia e infección esternal, y su prevalencia cada vez mayor en la población sometida a cirugía cardíaca. En el presente estudio se evalúa el beneficio clínico del uso profiláctico del refuerzo esternal de tipo Robicsek en los pacientes de alto riesgo que son intervenidos de cirugía cardíaca mayor. Pacientes y método. Se analiza a 290 pacientes consecutivos intervenidos mediante esternotomía media en nuestro centro. La indicación de refuerzo profiláctico esternal se estableció en casos de osteoporosis esternal severa o índice de masa corporal (IMC) >= 30, empleándose la técnica en 105 pacientes, 54 varones y 51 mujeres, cuya edad media era de 67,7 ± 9,1 años y con un IMC medio de 31,8 ± 4,1. Resultados. No hubo dehiscencias no infecciosas en el grupo con refuerzo de tipo Robicsek; sólo se produjo un caso (1,7%) de dehiscencia esternal debida a osteomielitis en el grupo reforzado, con buena respuesta a desbridamiento quirúrgico asociado con antibioterapia por vía intravenosa. Conclusión. El refuerzo de tipo Robicsek reduce la incidencia de dehiscencia esternal en los pacientes de alto riesgo y su indicación profiláctica debe ser considerada en casos de osteroporosis severa o IMC >= 30 (AU)
Introduction. Sternal deshidence is a relatively frequent complication in median sternotomy and causes high morbidity and mortality in cardiothoracic surgery. Obesity is one of the most important risk factors for sternal infection and deshidence and its prevalence is increasingly frequent in patients undergoing cardiac surgery. The aim of the present study was to assess the clinical benefit of the prophylactic use of robicsek sternal reinforcement in high-risk patients undergoing cardiac surgery. Patient and method. Two hundred ninety ninety consecutive patients who underwent median sternotomy in our center were analysed. The indications for prophylactic sternal reinforcement were severe sternal osteoporosis or a body mass indez (BMI) of >= 30. The technique was used in 105 patients, 54 men and 51 women, with a mean age of 67.7 +/- 9.1 years and a mean BMI of 31.8+/-4.1. Results. None of the patients in the reinforcement group developed non-infectious dehiscence; only one patient (1.7%) in this group showed sternal dehiscence due to osteomyelitis with good response to surgical debridement and intravenous antibiotics. Conclusion. Robicsek reinforcement reduces the incidence of sternal dehiscence in high-risk patients and its prophylactic use should be considered in patients with severe osteoporosis or a BMI of >=30 (AU)
Subject(s)
Male , Female , Adult , Aged , Middle Aged , Humans , Surgical Wound Dehiscence/prevention & control , Obesity/complications , Sternum/surgery , Cardiac Surgical Procedures/methods , Osteoporosis/complications , Suture Techniques , Body Mass IndexABSTRACT
INTRODUCTION: Sternal dehiscence is a relatively frequent complication in median sternotomy and causes high morbidity and mortality in cardiothoracic surgery. Obesity is one of the most important risk factors for sternal infection and dehiscence and its prevalence is increasingly frequent in patients undergoing cardiac surgery. The aim of the present study was to assess the clinical benefit of the prophylactic use of Robicsek sternal reinforcement in high-risk patients undergoing cardiac surgery. PATIENTS AND METHOD: Two hundred ninety consecutive patients who underwent median sternotomy in our center were analyzed. The indications for prophylactic sternal reinforcement were severe sternal osteoporosis or a body mass index (BMI) of > or = 30. The technique was used in 105 patients, 54 men and 51 women, with a mean age of 67.7 +/- 9.1 years and a mean BMI of 31.8 +/- 4.1. RESULTS: None of the patients in the reinforcement group developed noninfectious dehiscence; only one patient (1.7%) in this group showed sternal dehiscence due to osteomyelitis with good response to surgical debridement and intravenous antibiotics. CONCLUSION: Robicsek reinforcement reduces the incidence of sternal dehiscence in high-risk patients and its prophylactic use should be considered in patients with severe osteoporosis or a BMI of > or = 30.
