Efficacy of modified less invasive quick replacement using mild hypothermic arrest and partial retrograde cerebral perfusion for type A acute aortic dissection
Efficacy of modified less invasive quick replacement using mild hypothermic arrest and partial retrograde cerebral perfusion for type A acute aortic dissection
复制标题
改良微创快速置换术亚低温停搏加部分逆行脑灌注治疗A型急性主动脉夹层的疗效
DOI：
10.1007/s11748-017-0844-3
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发表时间：
2018
影响因子：
1.2
通讯作者：
Tanaka M
中科院分区：
文献类型：
--
作者：
Hata M;Orime Y;Wakui S;Umeda T;Akiyama K;Tanaka M
目的我们先前报道了一种称为“微创快速置换术(LIQR)”的独特技术，用于治疗中度低温停搏(28℃)的A型急性主动脉夹层。方法187例患者随机分为2组：L组，无脑灌注；M组，57例。改良LIQR在30℃下开始停循环，开放主动脉远端封闭术。结果M组附加瓣膜或冠状动脉手术的发生率(28.1%)明显高于L组(9.2%)。M组平均直肠温度(29.5℃)明显高于L组(27.4℃)。M组脑缺血时间(M7.7min；L 18.6min)、体外循环时间(M82.0min；L时间93.3min)、总手术时间(M145.2分钟；L时间154.2分钟)均明显缩短。术后脑损伤发生率L组6例(4.6%)，M组无一例。住院死亡率L组3例(2.3%)。M组患者均出院，无并发症发生。结论改良LIQR安全有效。这使得手术变得更快，而且是一种侵入性更小的过程。手术效果也很好。
ObjectiveWe previously reported a unique technique called “less invasive quick replacement (LIQR)” for treating type A acute aortic dissection with moderate hypothermic arrest (28 °C). This study examines the modified LIQR using mild hypothermic arrest (30 °C) with partial retrograde cerebral perfusion (RCP).Methods187 patients were divided into 2 groups: group L consisted of 130 patients underwent LIQR without any cerebral perfusion; group M consisted of 57 patients who were treated with modified LIQR. In modified LIQR, circulatory arrest was commenced under the 30 °C for open distal aortic stamp fixation. RCP was used during final half anastomosis of the prosthesis and then rapid re-warming was initiated.ResultsThe incidence of additional valve or coronary surgeries was significantly higher in group M (28.1%) than in group L (9.2%). The average rectal temperature was significantly higher in group M (29.5 °C) than in group L (27.4 °C). The durations of brain ischemia (M 7.7 min; L 18.6 min), cardiopulmonary bypass (M 82.0 min; L 93.3 min), and overall operation (M 145.2 min; L 154.2 min) were significantly shorter in group M. The incidence of postoperative brain damage was 6 patients (4.6%) in group L, but none in group M. The hospital mortality rate was 3 patients in group L (2.3%). All group M patients were discharged from the hospital without any complications.ConclusionModified LIQR is safe and effective. It makes the surgery much quicker and is a less invasive procedure. The surgical outcome was also favorable.