Rapid and safe establishment of cardiopulmonary bypass in repair of acute aortic dissection: improved results with double cannulation.
Rapid and safe establishment of cardiopulmonary bypass in repair of acute aortic dissection: improved results with double cannulation.
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DOI：
10.1510/icvts.2007.171546
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发表时间：
2008-12-01
影响因子：
--
通讯作者：
Sasaki, Hiroaki
中科院分区：
文献类型：
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作者：
Minatoya, Kenji;Ogino, Hitoshi;Sasaki, Hiroaki
在急性主动脉夹层修复术(AAD)中，对于哪一个部位的动脉插管是体外循环的最佳部位，目前尚无一致意见。我们采用右腋动脉插管(RAAC)联合股动脉插管来克服单一插管的缺点。2000年1月至2006年8月，88例AAD患者(平均年龄65+/-13岁，37名男性)接受了急诊手术修复。所有手术均在低温停循环下顺行选择性脑灌流。术前9例为休克，18例为血流灌注不良。停循环时间平均52±17min，心肌缺血平均135±53min。全弓置换术47例，半弓置换术41例。住院死亡率为2.3%(2/88)；死亡病例均为术前休克患者。围手术期卒中发生率为5.7%(5/88)。25例术前血流灌注不良患者的住院病死率为4.0%(1/25)，死亡病例为冠状动脉血流灌注不良。我们对AAD的治疗方法与低死亡率相关，即使在血流灌注不良的患者中也是如此。
There is no agreement at present as to which is the optimal site for artery cannulation for cardiopulmonary bypass in repair of acute aortic dissection (AAD). We have employed right axillary artery cannulation (RAAC) in combination with femoral artery cannulation to overcome the drawbacks of single cannulation. From January 2000 to August 2006, 88 patients underwent emergency surgical repair of the aortic arch (mean age 65+/-13 years, 37 men) for AAD. All operations were performed under hypothermic circulatory arrest with antegrade selective cerebral perfusion. Preoperatively, nine patients were in shock and 18 patients showed malperfusion. The average duration of circulatory arrest was 52+/-17 min and that of myocardial ischemia was 135+/-53 min. Total aortic arch replacement was done in 47 patients and hemiarch aortic replacement in 41. The hospital mortality rate was 2.3% (2 of 88); the fatal cases were among those who were in shock preoperatively. The perioperative stroke rate was 5.7% (5 of 88). The hospital mortality rate of the 25 patients with preoperative malperfusion was 4.0% (1 of 25); the fatal case had coronary malperfusion. Our approach for AAD was associated with a low mortality even in patients with malperfusion.