Tactics and Techniques of Aortic Arch Replacement
Tactics and Techniques of Aortic Arch Replacement
复制标题
主动脉弓置换术的策略和技术
DOI：
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发表时间：
1994
影响因子：
1.6
通讯作者：
M. Jurmann
中科院分区：
文献类型：
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作者：
H. Borst;Beate Buhner;M. Jurmann
未剥离和剥离主动脉弓的手术在主动脉置换的必要性和范围方面仍然存在挑战。本文以204例手术（58例动脉瘤，54例慢性夹层，92例急性夹层）为背景，从脑保护、手术选择和手术技术等方面对这些病变的治疗方法进行了描述。与保留部分或全部血管的管状弓置换术（33.7分钟）相比，保留主动脉上血管的弓吻合术的循环停止时间（17.2分钟）更短。急性夹层患者因脑并发症引起的早期死亡率最低（3/14死亡，2例患者术前出现脑损伤）。根据我们的经验，无论病因如何，我们建议对动脉瘤进行部分或全部弓置换。急性夹层应尽可能避免根治性弓手术。相反，应该探查弓，并在主动脉部分遇到的任何入口撕裂之外进行血液紧密的远端吻合。（J Card surgery 1994;9:53 38 - 547）
Operations on the nondissected and dissected aortic arch still pose challenges in terms of the need for and extent of aortic replacement. Our approaches to these lesions are described against the background of 204 operations (58 aneurysms, 54 chronic dissections, and 92 acute dissections), in terms of cerebral protection, procedural choices, and operative technique. Arch anastomoses sparing the supraaortic vessels had shorter periods of circulatory arrest (17.2 min) when compared to tubular arch replacement, with insertion of some or all of these vessels (33.7 min). Early death rates due to cerebral complications were lowest in acute dissections (3/14 fatalities, with two patients showing preoperative cerebral compromise). Based on our experience, we recommend doing subtotal or total arch repiacement in aneurysms regardless of cause. Radical arch surgery should be avoided in acute dissections whenever feasible. instead, the arch should be explored and a blood‐tight distal anastomosis made, going beyond any entry tears encountered in that aortic portion. (J Card Surg 1994;9:538–547)