Antegrade cerebral protection in thoracic aortic surgery: lessons from the past decade
Antegrade cerebral protection in thoracic aortic surgery: lessons from the past decade
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DOI：
10.1016/j.ejcts.2010.01.016
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发表时间：
2010-07-01
影响因子：
3.4
通讯作者：
Carrel, Thierry
中科院分区：
文献类型：
--
作者：
Kraehenbuehl, Eva S.;Clement, Michel;Carrel, Thierry
目的：长时间深低温停循环对胸主动脉手术的预后和生活质量产生不利影响。顺行脑灌注的几种技术是常规使用的：在无名动脉和左颈动脉插入导管的双侧选择性顺行脑保护(SACP)，经右腋窝顺行脑灌注(RAACP)的单侧脑灌注，或右腋窝灌注加左颈动脉附加导管(RAACCP)的组合，也导致双侧脑灌注。本研究的目的是分析不同方法对生活质量的影响。方法：对2004年1月至2007年12月在本院施行的292例胸主动脉直视手术患者的资料进行分析，并采用简明健康调查问卷(SF-36)对患者的生活质量进行随访。根据脑灌注类型和深低温心脏停搏时间对结果进行分析。结果：各组患者的特征相似。其中3.4%的患者接受了无ACP的深低温心脏直视手术(平均8.3+/-6.4min)，45.9%的患者接受了SACP(平均15.6+/-7.1min)，40.4%的患者接受了RAACP(平均28.1+/-11.6min)，9.4%的患者接受了双侧血流灌注(RAACCP)(平均43.1+/-16.7min)。平均随访23.2+/-15.1个月。各组患者的生活质量均得到保留。DHAA>40min时，双侧ACP较单侧RAACP提供更好的中期生活质量(SF-3695.1±44.4vs87.6+/-31.3；p=0.072)。结论：在评估中期生活质量时，双侧SACP对延长的深低温停搏(40分钟)提供了最佳的脑保护作用。(C)2010年欧洲心胸外科协会。爱思唯尔出版，版权所有。
Objective: Prolonged deep hypothermic circulatory arrest (DHCA) adversely affects outcome and quality of life in thoracic aortic surgery. Several techniques of antegrade cerebral perfusion are routinely used: bilateral selective antegrade cerebral protection (SACP) by introducing catheters in the innominate and left carotid artery, unilateral perfusion through the right axillary antegrade cerebral perfusion (RAACP) or a combination of right axillary perfusion with an additional catheter in the left carotid artery (RAACCP), resulting also in bilateral perfusion. The aim of the present study was to analyse the impact of the different approaches on the quality of life (QoL). Methods: The data of 292 patients who underwent surgery of the thoracic aorta using DHCA at our hospital between January 2004 and December 2007 have been analysed and a follow-up was performed focussing on QoL, assessed with the Short Form-36 Health Survey Questionnaire (SF-36). Results were analysed according to the type of cerebral perfusion and the duration of DHCA. Results: Patients' characteristics were similar in all groups. Of the total, 3.4% patients underwent DHCA (average 8.3 +/- 6.4 min) without ACP, 45.9% underwent SACP (average DHCA of 15.6 +/- 7.1 min), 40.4% had RAACP (average DHCA of 28.1 +/- 11.6 min) and 9.4% bilateral perfusion (RAACCP) (average DHCA of 43.1 +/- 16.7 min). The average follow-up was 23.2 +/- 15.1 months. QoL was preserved in all groups. For DHCA above 40 min, bilateral ACP provides superior midterm QoL than unilateral RAACP (average SF-36 95.1 + 44.4 vs 87.6 +/- 31.3; p = 0.072). Conclusions: When midterm QoL is assessed, bilateral SACP provides the best cerebral protection for prolonged DHCA (>40 min). (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.