Total arch replacement using aortic arch branched crafts with the aid of antegrade selective cerebral perfusion
Total arch replacement using aortic arch branched crafts with the aid of antegrade selective cerebral perfusion
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DOI：
10.1016/s0003-4975(00)01535-6
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发表时间：
2000-07-01
影响因子：
4.6
通讯作者：
Tamiya, Y
中科院分区：
文献类型：
--
作者：
Kazui, T;Washiyama, N;Tamiya, Y
背景我们报告了我们使用主动脉弓分支移植物进行全弓置换的临床经验，试图确定住院死亡率和神经功能结局的独立预测因素。我们研究了1990年5月至1999年6月期间采用主动脉弓分支移植物行全弓置换术的220例连续患者。所有手术均在低温体外循环、选择性脑灌注和开放性远端脑血管吻合的辅助下进行。总住院死亡率为12.7%。多变量分析显示，住院死亡率的独立决定因素是慢性肾功能衰竭、长泵时间、参与早期系列和休克。术后永久性神经功能障碍为3.3%。多因素分析显示，陈旧性脑梗死和泵时间是永久性神经功能障碍的独立决定因素。选择性脑灌注时间对住院死亡率或神经功能结局无显著影响。包括住院死亡在内的一年生存率为79% +/-6%。结论。选择性脑灌注可使复杂且耗时的全主动脉弓置换术更容易进行，并有助于降低主动脉弓动脉瘤和急性主动脉夹层患者的围手术期死亡率和发病率。(Ann Thorac Surg 2000;70：3-9）（C）2000年，胸外科医师协会。
Background. We report our clinical experience with total arch replacement using aortic arch branched graft in an attempt to determine the independent predictors of both in-hospital mortality and neurologic outcome.Methods. We studied 220 consecutive patients who underwent total arch replacement using aortic arch branched graft between May 1990 and June 1999. All operations were performed with the aid of hypothermic extracorporeal circulation, antegrade selective cerebral perfusion, and open distal anastomosis.Results. The overall in-hospital mortality rate was 12.7%. Multivariable analysis showed independent determinants of in-hospital mortality to be chronic renal failure, long pump time, participation in early series, and shock. Postoperative permanent neurologic dysfunction was 3.3%. On multivariable analysis, old cerebral infarct and pump time were independent determinants of permanent neurologic dysfunction. The selective cerebral perfusion time had no significant influence on in-hospital mortality or neurologic outcome. The Ei-year survival rate including in-hospital deaths was 79% +/- 6%.Conclusions. Selective cerebral perfusion allows increased ease of performance of total arch replacement, a complex and time-consuming procedure, and helps reduce periprocedural mortality and morbidity in patients with aortic arch aneurysm and those with acute aortic dissection. (Ann Thorac Surg 2000;70:3-9) (C) 2000 by The Society of Thoracic Surgeons.