Mellkasiaortastentgraft-beültetések Magyarországon 2012 és 2016 között = Thoracic aortic stentgraft implantations in Hungary from 2012 to 2016

Absztrakt: Napjainkban a vilagszerte elterjedt mellkasiaortastentgraft-beultetes hazankban is egyre nagyobb teret nyer. Eddig a hazai tapasztalatokrol atfogo beszamolo nem jelent meg. A modszer elterjedese folyamatban van, az eddigi eredmenyek elemzese a tovabbi kezelesi strategia optimalis meghatarozasa celjabol indokolt. A magyar mellkasi stentgraftműtetek perioperativ eredmenyeit elemeztuk 5 ev tapasztalatai alapjan. Retrospektiv, multicentrikus tanulmanyunk kereteben adatokat gyűjtottunk Magyarorszag minden mellkasi stentgraft-implantaciot vegző intezmenyeből. Az adatok jelentese onkentes volt, 5 ev mellkasi aortat erintő stentgraftbeultetesi adatait osszesitettuk. Magyarorszagon 2012 es 2016 kozott 131 mellkasiaortastentgraft-beultetest vegeztek. A ferfiak aranya 67,18%, a betegek atlageletkora 62,80 ev volt. Az elvegzett beavatkozas az esetek 25,19%-aban volt surgető. A betegek korelőzmenyeben 13,74%-ban szerepelt cukorbetegseg. A beavatkozast az esetek 64,89%-aban aneurysma, 17,56%-aban dissectio, 6,87%-aban traumas aortaserules es 10,69%-aban egyeb betegseg indikalta. Az aortadissectios esetek 73,91%-ban akutak voltak. Aneurysma miatt 16,47%-ban tortent akut beavatkozas ruptura miatt. A stentgraftbeultetesek 26,72%-aban vegeztek kiegeszitő revascularisatios műtetet a supraaorticus agakon (debranching). A posztoperativ időszakban az esetek 4,58%-aban alakult ki stroke, 1,53%-aban volt szukseg atmeneti vesepotlo kezelesre, es 2,29%-aban alakult ki belischaemia. Harminc napon beluli reoperaciora 5,34%-ban volt szukseg. A műtetek 30 napos mortalitasa 9,92% volt, az 5 eves utankovetes soran bekovetkezett hosszu tavu halalozas 16,03%-ot ert el. A mellkasi aorta stentgrafttal tortenő endovascularis helyreallito műtetje hatekony eljaras, előnyei egyertelműek a hazai adatok alapjan is a nyitott mellkasi műtetekkel szemben. Tovabbi hazai elterjedese a centralizalt ersebeszeti ellatas kialakitasanak es a megfelelő finanszirozasnak a fuggvenye. Az optimalis kezeles biztositasahoz elengedhetetlen a tarsszakmak jelenlete es a megfelelő logisztika biztositasa. Orv Hetil. 2018; 159(2): 53–57. | Abstract: Thoracic aortic endograft implantation has become a widespread procedure in recent years, yet no report is available about Hungarian outcomes. Examination of our results is crucial to define further treatment strategies. Analysis of perioperative data from Hungarian thoracic endograft implantations based on the experience of 5 years is presented. Our retrospective, multicentric study analysed voluntarily reported data from all Hungarian institutions where thoracic endograft implantations are performed. Information was collected from every procedure performed in 5 years. Between 2012 and 2016, 131 thoracic stent graft implantations were performed in Hungary (67.18% male, mean age 62.80 years). 25.19% of the procedures were acute. 13.74% of the patients were diabetic. Indications for the procedure were aneurysm (64.89%), dissection (17.56%), aortic trauma (6.87%) and other conditions (10.69%). 73.91% of the dissection cases were acute. 16.47% of repaired aneurysms were ruptured. Additional preoperative revascularization (debranching) was performed in 26.72% of the cases. Postoperative stroke occured in 4.58%, temporary hemodialysis was needed in 1.53%, bowel ischaemia was present in 2.29% and reoperation within 30 days was needed in 5.34% of all cases. Thirty-day mortality of the procedure was 9.92%, 5-year long-term mortality reached 16.03%. Endovascular repair of the thoracic aorta is an effective procedure and our national data comfirmed its advantages compared to open thoracic surgery. Further use of the procedure in Hungary depends on the centralised care in vascular surgery and financial matters. Multidisciplinary cooperation and proper logistics are needed to provide patients with optimal treatment. Orv Hetil. 2018; 159(2): 53–57.