Antegrade cerebral perfusion with a simplified technique: Unilateral versus bilateral perfusion
Antegrade cerebral perfusion with a simplified technique: Unilateral versus bilateral perfusion
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DOI：
10.1016/j.athoracsur.2005.08.079
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发表时间：
2006-03-01
影响因子：
4.6
通讯作者：
Thelin, S
中科院分区：
文献类型：
--
作者：
Olsson, C;Thelin, S
背景资料。选择性顺行脑灌注已被引入作为主动脉弓低温停循环手术的一种脑保护策略。已经描述了几种单侧和双侧脑灌注的技术，结果各不相同。患者接受右侧锁骨下动脉插管的单侧脑灌注或左侧颈动脉附加插管的双侧脑灌注。采用简化的Seldinger锁骨下动脉插管技术。对结果进行多变量Logistic回归分析和倾向性评分分析，以调整非随机治疗分配。65例患者中，17例(26%)为单侧脑血流灌注。病死率11%(n=7)，卒中14%(n=9)。在多变量分析中，单侧脑血流灌注与中风显著相关(优势比6.6[1.2对36])。年龄超过70岁与住院死亡相关(优势比12[1.3比113])，同时接受冠状动脉搭桥术与不良结局相关(优势比23[1-8比299])。在倾向评分分析的平衡变量中，中风在单侧脑血流灌注中显著更常见(29%对0%，p=0.045)。发生锁骨下动脉插管相关并发症1例(1.5%)。所描述的插管技术是安全有效的。双侧脑灌注很容易实现，与降低中风风险相关，应该是首选的脑保护策略。
Background. Selective antegrade cerebral perfusion has been introduced as a strategy of cerebral protection in operations on the aortic arch with hypothermic circulatory arrest. Several techniques of unilateral and bilateral cerebral perfusion have been described with varying results.Methods. Patients underwent either unilateral cerebral perfusion with a cannula in the right subclavian artery or bilateral cerebral perfusion, with an additional cannula in the left carotid artery. A simplified Seldinger-type technique for subclavian artery cannulation was employed. Results were analyzed with multivariable logistic regression analysis and propensity score analysis to adjust for nonrandomized treatment assignment.Results. Of 65 patients, 17 (26%) had unilateral cerebral perfusion. Mortality was 11% (n = 7); 14% (n = 9) had a stroke. In multivariable analysis, unilateral cerebral perfusion was significantly associated with stroke (odds ratio 6.6 [1.2 to 36]). Age more than 70 years was associated with in-hospital death (odds ratio 12 [1.3 to 113]), and concomitant coronary artery bypass graft surgery was associated with adverse outcome (odds ratio 23 [1-8 to 299]). Balancing variables in a propensity score analysis, stroke remained significantly more common with unilateral brain perfusion (29% versus 0%, p = 0.045). Complications associated with subclavian artery cannulation were encountered in 1 patient (1.5%).Conclusions. The described cannulation technique is safe and effective. Bilateral cerebral perfusion is easily achieved and is associated with decreased stroke risk, and should be the preferred brain protection strategy.