Surgical treatment of the distal aortic arch aneurysm using selective cerebral perfusion
Surgical treatment of the distal aortic arch aneurysm using selective cerebral perfusion
复制标题
选择性脑灌注手术治疗远端主动脉弓动脉瘤
DOI：
10.1007/978-4-431-65934-1_21
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
K. Sakuma
中科院分区：
文献类型：
--
作者：
K. Tabayashi;M. Ohmi;A. Iguchi;H. Yokoyama;H. Akimoto;T. Fukuju;Yoshiaki Tanaka;K. Sakuma
由于动脉瘤位于上纵隔和左胸之间，因此主动脉弓远端延伸至胸降主动脉的置换术是一项具有挑战性的手术。本研究的目的是检查心肌保护，选择性脑灌注（SCP）和手术方法的修改的有效性。1987年1月至1998年12月，共有74例主动脉弓远端动脉瘤患者接受了主动脉弓和胸降主动脉修复术。年龄55 ~ 80岁，平均69岁。所有患者均行胸骨正中切开术，13例需延长至第四或第五肋间隙。所有病例均在低温体外循环和SCR辅助下进行手术。其中53例主动脉弓至降主动脉完全置换，20例主动脉弓至降主动脉部分置换。此外，12例患者同时接受了冠状动脉旁路移植术。在三名需要二次手术的患者中进行了象鼻法。2例患者接受了二次胸腹主动脉置换术。平均体外循环时间266 min，心肌缺血时间118 min，食管温度19.3°C时SCP时间129 min。有9例住院死亡（12.1%）。1987-1995年住院死亡率为14.6%，1996-1998年为5.3%。术后发生脑血管意外4例（5.4%），其中2例偏瘫存活，另2例因深度昏迷死亡。自1995年以来，没有发生过脑血管意外。使用SCP置换延伸至胸降主动脉的主动脉弓是一种安全的手术，住院死亡率和脑血管意外发生率可接受。
Replacement of the distal aortic arch extending to the descending thoracic aorta is a challenging operation because of the location of the aneurysm between the upper mediastinum and left thorax. The objectives of this study were to examine the efficacy of modifications to myocardial protection, selective cerebral perfusion (SCP), and the operative method. Between January 1987 and December 1998 a total of 74 patients with distal aortic arch aneurysm underwent repair of the aortic arch and descending thoracic aorta. The ages of the patients ranged from 55 to 80 years (mean 69 years). All patients underwent median sternotomy, and 13 required extension into the fourth or fifth intercostal space. All cases were operated on with the aid of hypothermic cardiopulmonary bypass and SCR Complete replacement of the aortic arch extending to the descending thoracic aorta was performed in 53 patients and partial replacement of the aortic arch extending to the descending thoracic aorta in 20 patients. In addition, 12 patients underwent concomitant coronary aorta bypass grafting. The elephant trunk method was performed in three patients who required a secondary operation. Two patients underwent secondary replacement of the thoracoabdominal aorta. The average duration of cardiopulmonary bypass was 266 min and that of myocardial ischemia 118 min. The average duration of SCP was 129 min at an average esophageal temperature of 19.3°C. There were nine hospital deaths (12.1%). Hospital mortality was 14.6% in patients during 1987-1995 and 5.3% during 1996-1998. Postoperative cerebrovascular accidents occurred in four patients (5.4%), two of whom survived with hemiplegia; the other two died owing to deep coma. There have been no cerebrovascular accidents since 1995. Replacement of the aortic arch extending to the descending thoracic aorta using SCP is a safe procedure, with acceptable hospital mortality and incidence of cerebrovascular accidents.