Aortic arch replacement with a trifurcated graft
Aortic arch replacement with a trifurcated graft
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DOI：
10.1016/j.athoracsur.2006.11.015
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发表时间：
2007-02-01
影响因子：
4.6
通讯作者：
Griepp, Randall B.
中科院分区：
文献类型：
--
作者：
Spielvogel, David;Etz, Christian D.;Griepp, Randall B.
背景本研究的目的是回顾使用三叉弓移植物结合低温停循环（HCA）和选择性顺行脑灌注（SCP）进行主动脉弓置换术的结果。1999年9月至2005年12月，150例连续患者（91例男性;平均年龄63 ± 14岁;范围20 - 87岁）使用三叉弓移植物和HCA/SCP进行主动脉弓置换术。使用腋动脉进行插管;在HCA的短时间间隔内将三叉移植物缝合到弓血管;在近端和远端弓修复期间通过三叉移植物使用SCP，然后将三叉移植物缝合到弓移植物。55例患者患有慢性夹层; 48例患有动脉粥样硬化，29例患有退行性动脉瘤; 74例既往接受过心脏手术。38例患者接受了单独的主动脉弓重建术：同期手术包括升主动脉置换术74例;升主动脉和根部置换术21例;降主动脉置换术4例，冠状动脉旁路移植术36例。144例使用象鼻，但仅87例位于左锁骨下动脉远端; 34例位于左颈动脉远端，9例位于头臂和左颈动脉之间，18例位于所有弓支近端。平均HCA持续时间为31.1 ± 6.5分钟; SCP持续时间为66.6 ± 21.0分钟，平均温度为15.8 ± 2.1 ℃。150例患者中有13例（8.7%）发生不良结局：7例住院死亡和6例永久性卒中。仅7例患者出现暂时性神经功能障碍，9例需要透析的患者出现暂时性肾功能衰竭。使用HCA和SCP的三叉弓移植物是修复弓状动脉瘤的一种安全且通用的技术。
Background. The purpose of this study was to review the results of aortic arch replacement using a trifurcated arch graft in conjunction with hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SCP).Methods. One hundred fifty consecutive patients (91 male; mean age, 63 +/- 14 years; range, 20 to 87) had aortic arch replacement using a trifurcated arch graft and HCA/SCP from September 1999 to December 2005. The axillary artery was used for cannulation; a trifurcated graft was sewn to the arch vessels during a short interval of HCA; SCP was utilized through the trifurcation graft during the proximal and distal arch repair, and then the trifurcation graft was sewn to the arch graft. Fifty-five patients had chronic dissection; 48 had atherosclerotic and 29 had degenerative aneurysms; 74 had undergone previous cardiac surgery. Isolated arch reconstruction was undertaken in 38 patients: concomitant procedures included ascending aortic replacement in 74; ascending aorta and root replacement in 21; descending replacement in 4, and coronary artery bypass grafting in 36. An elephant trunk was used in 144, but distal to the left subclavian artery in only 87; in 34, it was distal to the left carotid, in 9, it was between the brachiocephalic and left carotid, and in 18, it was proximal to all arch branches. Mean HCA duration was 31.1 +/- 6.5 minutes; SCP lasted 66.6 +/- 21.0 minutes, at a mean temperature of 15.8 +/- 2.1 degrees C.Results. Adverse outcome occurred in 13 of 150 patients (8.7%): there were 7 hospital deaths and 6 permanent strokes. Temporary neurologic dysfunction was seen in only 7 patients, and renal failure was transient in 9 patients requiring dialysis.Conclusions. The use of a trifurcated arch graft with HCA and SCP is a safe and versatile technique for repair of arch aneurysms.