Outcome of thoracoabdominal aortic operations using deep hypothermia and distal exsanguination
Outcome of thoracoabdominal aortic operations using deep hypothermia and distal exsanguination
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DOI：
10.1016/s0003-4975(99)01542-8
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发表时间：
2000-03-01
影响因子：
4.6
通讯作者：
Althaus, U
中科院分区：
文献类型：
--
作者：
Carrel, TP;Berdat, PA;Althaus, U
背景。降主动脉和胸腹主动脉的手术可能会受到显着的围手术期发病率的影响，主要是因为脊髓缺血性损伤和腹部器官灌注不良。方法。对 1982 年至 1998 年间接受手术的两个连续系列患者进行了比较分析。第 1 组由 90 名接受中度低温左心搭桥手术的患者组成。第2组包括38名患者，使用深低温体外循环进行手术，并在进行近端吻合术和远端吻合术期间进行远端放血时停循环一段时间。结果。两组的主要人口统计学因素和主动脉疾病的原因相似。主动脉阻断组患者的早期死亡率（90 例中的 15 例，16%）显着高于停循环患者（38 例中的 2 例，5.2%），p < 0.001。亚低温组8例（8.8%）出现截瘫，深低温组仅1例（2.6%）出现截瘫。结论。根据我们的经验，深低温联合远端放血显着改善了降主动脉和胸腹主动脉术后的早期预后。该技术可以轻松实现近端和远端吻合，并且通过该方法不会显着延长手术时间。 (C) 2000 年，胸外科医师协会。
Background. Operation of the descending and thoracoabdominal aorta may be affected by a significant perioperative morbidity, mainly because of ischemic damage of the spinal cord and malperfusion of the abdominal organs.Methods. A comparative analysis was performed on two consecutive series of patients operated between 1982 and 1998. Group 1 consisted of 90 patients operated with moderate hypothermic left heart bypass. Group 2 included 38 patients operated using deep hypothermic cardiopulmonary bypass and a period of circulatory arrest while performing the proximal anastomosis and distal exsanguination during confection of the distal anastomosis.Results. Main demographic factors and causes of the aortic disease were similar in both groups. Early mortality was significantly higher in the group of patients with aortic cross-clamping (15 of 90, 16%) than in those operated with circulatory arrest (2 of 38, 5.2%), p < 0.001. Paraplegia occurred in 8 patients in the group operated with mild hypothermia (8.8%) but in only 1 patient (2.6%) when deep hypothermia had been used.Conclusions. In our experience deep hypothermia combined with distal exsanguination significantly improved the early postoperative outcome after operation of the descending and thoracoabdominal aorta. This technique allowed easy confection of proximal and distal anastomoses, and the duration of the operation was not prolonged significantly through this approach. (C) 2000 by The Society of Thoracic Surgeons.