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S Büket

Publications and source records attributed to S Büket.

24 records · Page 2Linked to original sources
PubMed1995

Subsequent proximal aortic operations in 123 patients with previous infrarenal abdominal aortic aneurysm surgery.

PURPOSE: Previous studies have reported that 3% to 8% of patients who have had resection of an infrarenal abdominal aortic aneurysm will subsequently have development of a new aortic aneurysm proximal to the repair. The actual incidence, pathogenesis, and natural history of these aneurysms are unclear. The purpose of this study is to better characterize subsequent proximal aortic aneurysms and to evaluate the outcome of their operative repair. METHOD: We retrospectively reviewed our recent experience with surgery for new proximal aortic aneurysms in 123 patients who had had a prior abdominal aortic aneurysmectomy. Seventy-two patients (58.5%) were admitted with chest or abdominal pain, six (4.9%) were admitted with ruptured aneurysms, and 41 (33.3%) were symptom free. Most subsequent aneurysms involved the thoracoabdominal aorta (n = 94; 76.4%); others involved the juxtarenal abdominal aorta, descending thoracic aorta, or transverse aortic arch. The new aneurysm was in continuity with the existing prosthetic graft in 101 cases (82.1%). Resection and graft replacement of the aneurysmal segment was performed on an emergency basis in patients with evidence of impending rupture and electively when aneurysmal diameter exceeded 5.5 cm. The average time interval between the two operations was 8.2 +/- 5.4 years. Mean aortic clamp and visceral ischemic times were 39.7 +/- 14.7 and 33.5 +/- 12.8 minutes, respectively. RESULTS: The in-hospital mortality rate was 12.2%. Complications included oliguric kidney failure in 11.4% and paraplegia in 4.1%. These results compare favorably with previous studies. CONCLUSION: On the basis of the significant prevalence of subsequent proximal aortic aneurysms and the high mortality rate associated with their rupture, we recommend resection of the entire infrarenal aorta during abdominal aortic aneurysm replacement, followed by long-term surveillance with biannual computed tomography or magnetic resonance imaging scanning of the chest and abdomen. Early diagnosis is facilitated by a high index of suspicion and allows surgical intervention to occur before life-threatening rupture. Both emergency and elective proximal aortic surgery in these patients can be performed with acceptable levels of morbidity and mortality.

Adult↗
PubMed1995

Marfan syndrome: the variability and outcome of operative management.

PURPOSE: This study reviews the contemporary surgical outcome of 69 patients with Marfan syndrome who underwent one or more aortic operations between July 18, 1989, and April 14, 1994. METHODS: During this 5-year period, 79 operations were performed including composite valve graft replacement (n = 28) and graft replacement of the thoracoabdominal aorta (n = 29). Fifty-seven additional operations had been performed before referral, for a total of 136 aortic operations in this group. Forty-two patients (60.9%) required multiple operations; 16 patients (23.2%) underwent three or more procedures. RESULTS: Follow-up was complete on all patients. The 30-day and long-term survival rates were 98.7% and 96.2%, respectively. Distal aortic replacement resulted in paraparesis in only one (2.6%) of 38 patients; no patient had development of paraplegia. No patient had a stroke after the use of profound hypothermic circulatory arrest. CONCLUSION: Aortic surgery prolongs survival in patients with Marfan syndrome and currently has low associated morbidity and mortality rates. Treatment often requires multiple staged operations. The variety and multiplicity of aortic manifestations in these patients demonstrate the necessity for lifelong cardiovascular surveillance to detect new or recurrent disease.

Acute Disease↗
PubMedDate not supplied

Spontaneous dissection of the left main coronary artery: a case report and review of the literature.

Primary spontaneous coronary artery dissection is an unusual occurrence. There have been less than 150 cases reported in world literature. This process frequently occurs in relatively young women, particularly in the peripartum or early postpartum period. This article reports the clinical course of one patient with primary spontaneous left main coronary artery dissection who was treated with coronary artery bypass grafting. To our knowledge, it is the second case to be treated with the use of left internal mammary artery.

Adult↗
PubMedDate not supplied

Techniques for retrograde cerebral perfusion in the treatment of aortic lesions via left thoracotomy.

Retrograde cerebral perfusion under deep hypothermic circulatory arrest is a simple and useful adjunct in aortic surgery and is performed by many surgeons in the treatment of aortic arch pathology. In recent years, this technique has been recommended in the surgery of distal arch and proximal descending aortic lesions through a left thoracotomy inclusion. The aim of the technique is to increase the right atrial pressure for retrograde cerebral perfusion. After cooling using femorofemoral bypass, circulatory arrest is initiated. The right atrial pressure is increased to 20 mmHg, and retrograde cerebral circulation results. In this article, five patients with distal aortic arch and proximal descending thoracic aortic lesions who were operated on by using this technique were evaluated. It is suggested that this technique can be used with a lateral thoracotomy approach that is suitable for procedures on a distal aortic arch and proximal descending aorta.

Adult↗
PubMedDate not supplied

Determinants of early mortality and neurological morbidity in aortic operations performed under circulatory arrest.

OBJECTIVE: Aneurysms and dissections of the thoracic aorta continue to present a surgical challenge and their incidence is increasing in recent years. The mortality rate of surgical treatment is still higher than those of other cardiovascular operations. Neurological injury is the most feared complication resulting from repair of these lesions. This study aims to determine the factors that influence the neurological outcome and mortality after thoracic aortic operations. METHODS: During the period from November 1993 through May 1999, 144 patients were operated on for conditions involving the ascending aorta and/or aortic arch. Ninety-five (66.0%) were operated for aortic dissection and 49 (34.0%) were for aortic aneurysms. Sixty-two patients (43.1%) had replacement of ascending aorta with distal open technique; 82 patients (56.9%) had hemiarch or total arch replacement or repair of the distal arch. RESULTS: Twenty-seven (18.7%) early deaths occurred. New stroke occurred in two patients (1.4%) and temporary neurological dysfunction in nine patients (6.3%). Deep hypothermic circulatory arrest with retrograde cerebral perfusion was used in all patients. On multivariate logistic regression analysis, risk factors for mortality were chronic renal failure, preoperative organ malperfusion, rupture, total circulatory arrest time > 60 minutes, postoperative acute renal failure, postoperative low cardiac output, sepsis, and multiple organ failure. Risk factors for neurological morbidity were preoperative chronic renal failure, preoperative hemodynamic instability, postoperative low cardiac output, and pulmonary complications. CONCLUSIONS: Hypothermic circulatory arrest with retrograde cerebral perfusion was not an independent predictor of neurological morbidity on multivariate analysis, even if the arrest period was more than 60 minutes. Lengths of circulatory arrest periods and clinical presentations of the patients are important determinants of mortality.

Adolescent↗