Aortic arch replacement using selective cerebral perfusion
Aortic arch replacement using selective cerebral perfusion
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DOI：
10.1016/j.athoracsur.2006.10.082
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发表时间：
2007-02-01
影响因子：
4.6
通讯作者：
Suzuki, Takayasu
中科院分区：
文献类型：
--
作者：
Kazui, Teruhisa;Yamashita, Katsushi;Suzuki, Takayasu
背景资料。本研究旨在报告我们应用选择性脑灌流(SCP)行主动脉弓置换的临床经验，并确定住院死亡率和神经预后的独立预测因素。我们研究了1986年1月至2006年2月间使用SCP行主动脉弓置换手术的连续472名患者。所有手术均在低温体外循环(SCP)的辅助下进行，大多数情况下采用全身停循环开放远端吻合术。主动脉疾病的病因包括急性主动脉夹层126例(27%)，慢性主动脉夹层102例(21%)，退行性动脉瘤245例(52%)。全弓置换术420例(%)。平均SCP时间为88+/-32分钟。总的住院死亡率为9.3%，但最近266名患者的死亡率显著下降至4.1%。早期病程、肾/肠系膜缺血、体外循环时间、年龄增加、慢性肾功能不全、脑血管意外(CVA)病史、既往升支或弓形手术是院内死亡的独立预测因素。术后暂时性和永久性神经功能障碍发生率分别为4.7%和3.2%。CVA病史是暂时性神经功能障碍的唯一预测因素，而CVA和泵血时间是永久性神经功能障碍的独立预测因素。SCP时间与住院病死率和神经学转归无明显相关性。SCP有助于复杂的主动脉弓置换，从而降低弓部动脉瘤或夹层的死亡率和发病率。
Background. The present study was conducted to report our clinical experience with aortic arch replacement using selective cerebral perfusion (SCP) and determine the independent predictors of in-hospital mortality and neurologic outcome.Methods. We studied 472 consecutive patients who underwent aortic arch replacement using SCP between January 1986 and February 2006. All operations were performed with the aid of hypothermic extracorporeal circulation, SCP, and in most cases, systemic circulatory arrest for open distal anastomosis. The etiology of aortic diseases included acute aortic dissection in 126 patients (27%), chronic aortic dissection in 102 (21%), and degenerative aneurysm in 245 (52%). Total arch replacement was performed in 420 patients (89%). Mean SCP time was 88 +/- 32 minutes.Results. The overall in-hospital mortality was 9.3%, but it dropped significantly to 4.1% in the most recent 266 patients. Independent predictors of in-hospital mortality were early series, renal/mesenteric ischemia, pump time, increasing age, chronic renal dysfunction, history of cerebrovascular accident (CVA), and previous ascending or arch operation. Overall postoperative temporary and permanent neurologic dysfunction were 4.7% and 3.2%, respectively. A history of CVA was the only predictor of temporary neurologic dysfunction, whereas CVA and pump time were independent predictors of permanent neurologic dysfunction. SCP time had no significant correlation with in-hospital mortality and neurologic outcome.Conclusions. SCP facilitates complicated aortic arch replacement, resulting in a reduction of mortality and morbidity for arch aneurysms or dissections.