Proximal aortic perfusion for complex arch and descending aortic disease.
Proximal aortic perfusion for complex arch and descending aortic disease.
复制标题
复杂主动脉弓和降主动脉疾病的近端主动脉灌注。
DOI：
10.1016/s0022-5223(98)70454-4
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
T. Katsumata
中科院分区：
文献类型：
--
作者：
S. Westaby;T. Katsumata
目的在主动脉弓的低温停循环手术中，常规采用股动脉造袢术。对于合并弓和降主动脉疾病，建议采用两阶段入路。这些方法与栓塞或灌注不良引起的重要神经损伤有关。因此，我们通过延长左开胸术改为中央插管技术。方法采用升主动脉插管和肺动脉静脉引流术，对18例弓形或合并病状的患者行低温循环骤停一期修复术。因出血或剥离而进行紧急手术。降主动脉置换术后脑及心肌灌注恢复。结果1例老年患者术后恢复后因消化道出血死亡（总死亡率5.6%，范围0.14% ~ 27%,p = 0.05）。一个可能的短暂性单眼发生，但没有计算机断层扫描栓塞的证据。手术方法未发生其他重大事件和并发症。结论扩大左开胸中心置管行顺行脑灌注可安全一期替代弓降主动脉。我们相信这种方法可以减少弓和降主动脉手术中的脑并发症。[J]; journal of nurses training; 2009; 17 - 17。
ObjectiveCannulation of the femoral artery is used routinely for hypothermic circulatory arrest operations on the aortic arch. A two-stage approach is advocated for combined arch and descending aortic disease. These methods are associated with important neurologic injury through embolism or malperfusion. We therefore changed to a central cannulation technique through extended left thoracotomy.MethodsEighteen patients with arch or combined pathologic conditions underwent one-stage repair with hypothermic circulatory arrest using ascending aortic cannulation and venous drainage from the pulmonary artery. Emergency operations were performed for bleeding or dissection. Cerebral and myocardial perfusion were restored during descending aortic replacement.ResultsOne elderly patient died of gastrointestinal hemorrhage after initial recovery (overall mortality 5.6%, range 0.14% to 27%, p = 0.05). One possible transient monoparesis occurred but without computed tomographic scan evidence of embolism. No other significant events and no morbidity occurred from the surgical methods.ConclusionsExtended left thoracotomy with central cannulation allows safe one-stage replacement of the arch and descending aorta using anterograde cerebral perfusion. We believe that this method will reduce cerebral complications in arch and descending aortic operations. (J Thorac Cardiovasc Surg 1998;115;162–7)