Læknablaðið - 15.05.2004, Qupperneq 46

ÞING SKURÐLÆKNA, SVÆFINGA- OG GJÖRGÆSLULÆKNA / ÁGRIP ERINDA
relatively high mortality and morbidity. In recent years endovas-
cular Stent-graft treatment of TAA has become an alternative ap-
proach. The combined approach provides the reliability of the open
surgical treatment and less invasiveness of the endovascular treat-
ment. However this treatment has several limitations on account of
the anatomy of the aorta proximal and distal to the aneurysm.
Methods: In our clinical experience five patients with TAA were
treated with open surgery combined with endovascular stent-graf-
ting. One patient had distal arch aneurysm, one had transverse arch
and descending aortic aneurysms, and three patients had descen-
ding aortic aneurysms. One patient had aortic valve repair and one
a CABG, in addition. All patient underwent surgery under deep
hypothermic circulatory arrest. The circulatory arrest time ranged
from 33 to 54 min (mean, 38.2 min), and selective retrograde perfu-
sion time from 25 to 52 min (mean, 36 min).
Kcsults: All patients survived the procedure. However, one patient
developed paraplegia and another patient had to undergo second
EVSG procedure due to distal endo-leak. Various surgical tech-
niques employed will be discussed.
Conclusions: Combined surgical and EVSG trealment for TAA is
less invasive and may be considered as an alternative treatment for
TAA. The surgical technique is, however under evolution.
E - 25 Rf-Maze aðgerð, nýjung í meðferð gáttaflökts
Bjarni Torfason', Gizur Gottskálksson2
'Hjarta- og lungnaskurðdeild og 2hjartadeild Landspítala
Inngangur: Reikna má með að eitt til tvö þúsund sjúklingar á ís-
landi séu með gáttaflökt (fibrillatio atriorum). Sjúkdómurinn
íþyngir sjúklingum verulega og eykur líkur á hjartabilun og dauða.
Þrátt fyrir blóðþynningu og aðra lyfjameðferð er áhætta af sjúk-
dómnum mikil bæði vegna segamyndunar, blóðtappa og blæðinga
af völdum blóðþynningarinnar. Mikill sjúkrahúskostnaður er af
þessum sjúkdómi, sérstaklega vegna endurtekinna innlagna. Arið
1987 lýsti James Cox stórri opinni hjartaskurðaðgerð, svokallaðri
Maze-Cox aðgerð, þar sem framhólf hjartans voru skorin í strimla
og svæði eftir sérstöku landakorti í því skyni að lækna sjúkdóminn.
Aðgerðin hefur reynst árangursrík en áhættusöm. Nú hefur komið
fram ný og hættuminni aðgerð sem er eftirlíking af fyrri aðgerð. í
stað þess að skera framhólfin í strimla og eyjar eru sambærilegar
línur í framhólfunum hitaðar með útvarpsbylgjum og þannig fengin
einangrun gegn rafvirkni á svipaðan hátt eins og ef um skurði væri
að ræða.
Efniviður og aðferðir: í desember 2002 var tekin upp á íslandi ný
aðgerð við viðvarandi gáttaflökti, svokölluð Rf-Maze aðgerð. Ábend-
ing aðgerðar var viðvarandi gáttaflökt í a.m.k. eitt ár og sjúklingum
boðin Rf-Maze aðgerð aðeins ef til stóð að gera opna hjartaskurð-
aðgerð með hjarta-lungnavél vegna annars sjúkdóms, svo sem sjúk-
dóms í kransæðum og/eða hjartalokum. Farið var yfir sjúkraskrár
og sjúklingum fylgl eftir varðandi árangur aðgerðanna. Helstu
skrefum aðgerðarinnar er lýst með skýringarmyndum og myndum
úr aðgerð.
Niðurstöður: Alls gengust níu sjúklingar undir Rf-Maze aðgerð á
hjarta- og lungnaskurðdeild Landspítala. Um var að ræða sjúklinga
með alvarlega hjartasjúkdóma auk gáttaflökts. Aðgerðartími lengd-
ist um um það bil 1/2 klukkustund vegna Rf-Maze aðgerðarinnar.
Fylgikvillar tengdir Rf-Maze aðgerðinni sáust ekki í eða eftir að-
gerðina.
Ályktun: Rf-Maze aðgerð er fýsilegur kostur fyrir sjúklinga með
viðvarandi gáttaflökt sem þurfa að fara í opna hjartaskurðaðgerð af
öðrum sökum. Aðgerðin er fljótleg og truflar ekki megin hjarta-
skurðaðgerðina sem sjúklingurinn þarfnast.
E - 26 Surgical treatment in the evolving phase of acute
myocardial infarction
Sonia M. Collins, Tomas Molund, Johan Nilsson, Atli Eyjólfsson,
Lars Algotsson, Per Johnsson
Dept. Cardiothoracic Surgery, University Hospital of Lund, Lund,
Sweden.
Background: Acute myocardial infarction (AMI) can be treated
with thrombolysis or coronary catheter intervention. Coronary
artery bypass grafting (CABG) is reserved for the patients in whom
other procedures have failed (AHA/ACC guidelines). Between
January 2001 and December 2002 we performed CABG in 88
patients during the evolving phase of AMI, and analyzed their
short-term and mid-term results.
Methods: Preoperative, intraoperative, and postoperative data
were analyzed in patients who underwent emergency CABG for
AMI between January 1, 2001, and December 31, 2002. CABGs
performed more than 7 days after AMI were excluded from this
study.
Results: 88 patients (64 males and 24 females) with AMI were
treated with emergency CABG. Average age was 68,8 yrs (range
41-87). Intraaortic balloon pumping (IABP) was used in 41 cases
preoperatively, in 3 cases IABP was inserted postoperatively.
Twenty patients presented in cardiogenic shock at time of opera-
tion. 72% of the patients presented within 72 hrs from the onset of
AMI. Off-pump surgery was performed in 9 patients (10%). The
mean number of bypass grafts was 4 (range 1-7), and at least 1 ar-
terial conduit was used in 54 cases (61%). Aortic clamp time, CPB
time, and operative time were 46 (range 9-132), 90 (range 37-253),
and 187 (range 110-425) min, respectively. The patients were extu-
bated 10.3 (range 2.5-251) hours after surgery, remained in ICU for
2 (range 0-17) days, and were discharged from the hospital after 8
(0-38) days. The overall 30-day mortality rate was 14%, 25% (5 of
20) in the group with cardiogenic shock, whereas it was 10% (7pts)
in the group without. The actuarial 1-year survival rate 82%.
Condusions: Although our results are limited, emergency CABG
was found to be safe and feasible for AMI in patients without
cardiogenic shock or unstable myocardial ischemia. The outcome
of this procedure for patients with preoperative cardiogenic shock
was quite satisfactory, therefore, a combination therapy of appro-
priate mechanical circulatory support, prior revascularization by
catheter intervention, and emergency surgical revascularization are
considered to improve survival of those patients.
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