Controlling Bleeding From Proximal and Coronary Ostial Anastomoses By Using Blood Cardioplegia Delivering Antegradely While Performing Bentall Procedure

Abstract

Bentall procedure is one of the valved conduit techniques which is used in the treatment of aortic valve diseases accompanied by ascending aortic aneurysm and dissection and it is used commonly around the world. In Bentall procedure, which is a complicated and long surgery, the rate of mortality and morbidity are not only related to the operation itself but also to the complications like major neurological events, myocardial damage and bleeding which take place during the intraoperative and postoperative period. Although the quantity and frequency of bleeding is declined with teflon strips and biological tissue glues, modifications of Bentall procedure are still an important problem. This study was conducted retrospectively with 48 patients in terms of early results of complication of bleeding caused specifically by proximal suture line and coronary ostium anastomosis lines controlled by the method of blood cardioplegia while performing Bentall procedure and supracoronary aort replacement in our clinic.

Keywords

• Cardiopulmonary bypass; cardioplegic solutions; hemorrhage.

Bentall Prosedürü Sırasında Proksimal ve Koroner Ostiyum Anastomozlarından Oluşabilecek Kanamaların Antegrad Verilen Kan Kardiyoplejisiyle Kontrolü

Abstract

Bentall prosedürü, aort kapak hastalıkları ile birlikte seyreden asendan aort anevrizması ve aort diseksiyonlarının tedavisinde uygulanan kapaklı konduit tekniklerinden biri olup tüm dünyada yaygın olarak kullanılmaktadır. Komplike ve uzun bir ameliyat olan Bentall prosedüründe mortalite ve morbidite oranları sadece ameliyatın kendisine değil aynı zamanda intraoperatif ve postoperatif dönemde meydana gelebilecek santral nörolojik olay, miyokardiyal hasar ve kanama gibi komplikasyonlarla da ilişkilidir. Kanama probleminin önlenebilmesi için geliştirilen Bentall prosedürünün modifikasyonları, teflon stripler ve biyolojik doku yapıştırıcıları ile kanama miktarı ve sıklığı azalmış olsa da halen önemli bir sorun olarak gündemdedir. Kliniğimizde Bentall prosedürü ve suprakoroner aort replasmanı uygulanan 48 hastada özellikle proksimal sütür hattından ve koroner ostiyum anastomoz hatlarından meydana gelebilecek cerrahi kanamalar, antegrad verilen kan kardiyoplejisi yöntemi ile erken dönem sonuçları açısından retrospektif olarak incelenmiştir.

Keywords

• Kardiyopulmoner baypas, kardiyoplejik solüsyonlar, kanama.

References

1. Cooley DA, DeBakey ME: Resection of the entire ascending aorta in fusiform aneurysm using cardiac bypass. JAMA 1956; 162:1158.
2. Westaby S, Cecil B: Surgery of the thoracic aorta, in Westaby S (ed): Landmarks in Cardiac Surgery. Oxford, Isis Medical Media, 1997;223.
3. Bentall H, De Bono A: A technique for complete replacement of the ascending aorta. Thorax 1968; 23: 338-9
4. Stowe CL, Baertlein MA, Wierman MD, Rucker M, Ebra G: Surgical management of ascending and aortic arch disease: Refined techniques with improved results. Ann Thorac Surg 1998; 66: 388-95
5. Svensson LG, Nadolny EM, Kimmel WA: Multimodal proto- col influence on stroke and neurocognitive deficit prevention after ascending/arch aortic operations. Ann Thorac Surg 2002; 74: 2040.
6. Svensson LG: Brain protection. J Card Surg 1997; 12: 326-9 7. Wareing TH, Davila-Romen VG, Daily BB, Murphy SF, Schechtman KB, Barzilai B, et al: Strategy for the reduction of stroke incidence in cardiac surgical patients. Ann Thorac Surg 1993; 55: 1400-7
7. Coselli JS, LeMaire SA: Experience with retrograde cerebral perfusion during proximal aortic surgery in 290 patients. J Card Surg 1997; 12: 322-5
8. Safi HJ, Letsou GV, Iliopulos AC, Subramaniam MH, Millerr CC, Hassoun H et al: Impact of retrograde cerebral perfusion on ascending aortic and arch aneurysm repair. Ann Thorac Surg 1997; 63: 1601-7

9. Griepp RB, Ergin MA, McCullough JN, Nguyen KH, Juvonen T, Chang N et al: Use of hypothermic circulatory arrest for ce- rebral protection during aortic surgery. J Card Surg 1997; 12: 312-21
10. Kouchoukos NT: Adjuncts to reduce the incidence of em- bolic brain injury during operations on the aortic arch. Ann Tho- rac Surg 1994; 57: 243-5
11. Gelsomino S, Morocutti G, Frassani R, Masullo G, Da Col P, Spedicato L et al: Long-term results of Bentall composite aor- tic root replacement for ascending aortic aneurysms and dis- sections. Chest 2003; 124: 98-8
12. Nezic D, Cirkovic M, Knezevic A, and Jovic M. Modified Ben- tall procedure – ‘a collar technique’ to control bleeding from co- ronary ostia anastomoses. Interact Cardiovasc Thorac Surg 2008; 7: 709-11.
13. Hirasawa Y, Aomi S, Saito S, Kihara S, Tomioka H, and Ku- rosawa H. Long-term results of modified Bentall procedure using flanged composite aortic prosthesis and separately inter- posed coronary graft technique. Interact Cardiovasc Thorac Surg 2006; 5: 574-7.
14. Settepani F, Eusebio A, Ornaghi D, Barbone A, Citterio E, Manasse E, et al. Aortic root replacement with the Carboseal composite valve graft: analysis of risk factors. Interact Cardio- vasc Thorac Surg 2005; 4: 360-4