Nachhaltigkeit der Aorta aszendens Reduktionsplastik bei 75 Patienten nach operativem Aortenklappenersatz
Übersetzter Titel:
Effectiveness of Ascending Aortoplasty in 75 patients undergoing aortic valve replacement
Autor:
Chajet, Daniel
Jahr:
2010
Dokumenttyp:
Dissertation
Fakultät/School:
Fakultät für Medizin
Betreuer:
Wildhirt, Stephen M. (Prof. Dr. med.)
Sprache:
de
Fachgebiet:
MED Medizin
Kurzfassung:
Die aortale Reduktionsplastik ist eine gängige Methode zur effektiven und nachhaltigen Durchmesser Reduktion bei Patienten mit Herzklappenvitien und begleitender Aortendilatation. Bei Beachtung der empfohlenen Indikationen (poststenotische Dilatation <5-6 cm, Ausschluss einer zystischen Medianekrose, ausreichende Reduktion auf <3.5 cm Durchmesser) lässt sich eine nicht von extern verstärkte Reduktionsplastik sicher und nachhaltig effektiv anwenden.
Übersetzte Kurzfassung:
Objective: Ascending aortic dilatation (AAD) of >5 cm is present in 5-15 % of patients with aortic valve disease with a 14 % annual risk of suffering from aortic rupture or dissection. Surgical treatment of AAD includes reduction aortoplasty or prosthetic replacement. Controversy exists as to whether reduction of the aortic diameter is equivalent to prosthetic replacement. Seventyfive patients underwent reduction ascending aortoplasty without external re-inforcement of the aorta in combination with other cardiac procedures at our institution. The diameter of the ascending aorta was measured before surgery and between 1.1 and 5.6 (mean: 2.98) years postoperatively using computed tomography. Histological examination excluded specific aortic diseases in these patients. Perioperative mortality rate was 5.3 % (n=4). Maximum AAD was 5.0+0.6 cm preoperatively. At follow-up ascending aortic diameter was reduced to 4.4 +0.5 cm (p<0.001) at pulmonary trunk level and 3.8+0.6 cm at the sinu-tubular junction (p<0.001). 7 of 75 (9.3%) patients showed aortic dilatation of more than 5 cm (5.4+0.4 cm) postoperatively. Preoperative AAD of >5 cm was a significant predictor for postoperative re-dilatation of the aorta. Reduction ascending aortoplasty is an effective technique with long lasting effect only in patients presenting with moderate size ascending aortic aneurysm (< 5cm).
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