Arch and descending aortic aneurysms: influence of perfusion technique on neurological outcome
Arch and descending aortic aneurysms: influence of perfusion technique on neurological outcome
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DOI：
10.1016/s1010-7940(98)00310-8
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发表时间：
1999-02-01
影响因子：
3.4
通讯作者：
Vaccari, G
中科院分区：
文献类型：
--
作者：
Westaby, S;Katsumata, T;Vaccari, G
目的：在低温停循环的胸主动脉手术中，虽然常规使用股动脉插管，但通过降主动脉逆行灌流存在脑灌注不良或血栓的风险。因此，自1995年以来，我们常规使用中心插管技术进行远端弓和降主动脉手术。在这项研究中，我们比较了连续接受股动脉和升主动脉灌注治疗这些动脉瘤的患者的神经学结果。方法：1987~1998年间，对61例主动脉弓和降主动脉病变患者行主动脉切除并停循环，但不进行逆行脑灌流。31例为梭形真性动脉瘤，19例为主动脉夹层，11例为广泛囊状或假性动脉瘤。A组32例(52%)经股动脉灌注，B组29例(48%)经升主动脉灌注。我们回顾了手术死亡率和发病率，以及神经学结果。结果：两组在平均年龄、病理、腹部和外周血管病变、净灌流时间或循环停止时间方面没有差异。住院死亡4例(A组3例，B组1例；P=0.61)，其中A组1例神经系统死亡，A组神经系统事件发生率(9例：28%)高于B组(2例：7%；P=0.03)。两组均出现暂时性局灶性神经功能障碍(A组2例，6%；B组2例，7%；P>；0.99)，但永久性损伤仅发生在A组(7例：单瘫4例，偏瘫1例，弥漫性脑损伤2例，死亡1例，P=0.01)。结论：使用近端主动脉插管顺行灌流。脑血栓的风险较低，并可在低发病率的情况下进行广泛的主动脉切除术。(C)1999由爱思唯尔科学公司出版。版权所有。
Objective: Although cannulation of the femoral artery is used routinely for thoracic aortic operations with hypothermic circulatory arrest, retrograde perfusion through the descending aorta carries the risk of cerebral malperfusion or embolism. We have, therefore, routinely used a central cannulation technique for distal arch and descending aortic operations since 1995. In this study, we compared neurological outcome in consecutive patients undergoing femoral versus ascending aortic perfusion for these aneurysms. Methods: Between 1987 and 1998, 61 patients underwent aortic resection with circulatory arrest, but without retrograde cerebral perfusion, for lesions of the aortic arch and descending aorta. Thirty-one patients had fusiform true aneurysms, 19 had aortic dissection and 11 had extensive saccular or false aneurysms. Thirty-two patients (52%) were perfused via the femoral artery (group A), and 29 patients (48%) from the ascending aorta (group B). Operative mortality and morbidity, and neurological outcome, were reviewed. Results; There were no differences between the groups in mean age, pathology, abdominal and peripheral vascular disease, net perfusion time, or circulatory arrest time. There: were four hospital deaths (three in group A and one in group B; P = 0.61), including one neurological death in group A, group A suffered a higher incidence of neurological events (nine patients: 28%) than group B (two patients: 7%; P = 0.03). Temporary focal neurological deficits occurred in both groups (two patients in group A, 6% and two patients in group B, 7%; P > 0.99), but permanent injury occurred exclusively in group A (seven patients: four with monoplegia, one with hemiplegia, and two with diffuse cerebral injury with one death: P = 0.01). Conclusions: Anterograde perfusion using a proximal aortic cannula. provides a low risk of cerebral embolism and allows extensive aortic resection with low morbidity. (C) 1999 Published by Elsevier Science B.V. All rights reserved.