Surgical and Medical Follow-Up Results of Type III Aortic Dissections

Objectives: This study was planned to evaluate the results of surgical and medical treatment in descending aortic dissections. Patients and Methods: The study included 22 patients presented with DeBakey type III dissection between January 1999 and March 2002. While 11 patients (8 males, 3 females; mean age 56.6aplusmn;11.9) were treated surgically, 11 patients (10 males, 1 female; mean age 72.8aplusmn;7.7) were followed up by medical therapy. Patients operated and patients followed up with medical treatment were called and evaluated for pain history, physical examination signs, and thoracoabdominal computed tomography with 6-month intervals. Results: Of surgically treated patients, two had acute descending aortic rupture, nine had acute type III dissection unresponsive to medical therapy. Seven patients died (63.6%). Comorbid diseases, excessive bleeding during the operation and blood transfusion, cross clamp time and development of low cardiac output were found to be the causes of high mortality. Although early results in surgical group were poor, late results in surgical and medical groups were similar. In the follow-up (6-28 months) of medically treated patients distal organ ischemia or aortic diameter increase were seen, there were no complications or mortality. Conclusion: Type III dissection is a disease with high mortality and morbidity. Patientsa#39; response to medical therapy were found to be good. Turkish Baslik: Tip 3 Aortik Diseksiyonlarin Cerrahi ve Tibbi Takip Sonuclari Anahtar Kelimeler: Diseksiyon; cerrahi tedavi; tibbi takip; aort capi. Amac: Bu calisma desendan aort diseksiyonlarinda cerrahi tedavi ile tibbi tedavi sonuclarinin degerlendirilmesi amaciyla yapildi. Hastalar ve Yontemler: Ocak 1999 ile Mart 2002 tarihleri arasinda klinigimize basvuran DeBakey tip 3 diseksiyonlu 22 hasta calismaya alinmistir. On bir hastaya (8 erkek, 3 kadin; ort. yas 56.6aplusmn;11.9) cerrahi tedavi yapilirken, 11 hasta (10 erkek, 1 kadin; ort. yas 72.8aplusmn;7.7) tibbi tedaviyle izlenmistir. Ameliyat olan ve tibbi tedavi ile izlenen hastalar alti aylik aralarla kontrole cagrilarak agri oykusu, fizik muayene bulgulari ve torakoabdominal bilgisayarli tomografi ile degerlendirilmistir. Bulgular: Cerrahi yapilan hastalarin ikisi akut desendan aort rupturu, dokuzu tibbi tedaviye direncli akut tip 3 diseksiyondur. Hastalarin yedisi kaybedilmistir (%63.6). Eslik eden komorbid hastaliklar, ameliyatta asiri kanama ve kan transfuzyonu, kros klemp suresi ve dusuk kardiyak debi gelisimi, yuksek mortalitenin nedenleri olarak bulunmustur. Erken donem cerrahi sonuclarinin kotu olmasina ragmen, yasayan hastalardaki gec donem sonuclari, tibbi ve cerrahi grupta benzerdir. Tibbi tedavi ile izlenen tum hastalarin takiplerinde (6-28 ay) distal organ iskemisi ve aort caplarinda artis izlenmistir, mortalite ya da komplikasyon gelismemistir. Sonuc: Tip 3 aort diseksiyonu, mortalite ve morbiditesi yuksek olan bir hastaliktir. Tibbi tedavi ile izlenen hastalarin tedaviye yanitlari iyi bulunmustur.