Open thoracoabdominal aortic aneurysm surgery technique: how we do it
Open thoracoabdominal aortic aneurysm surgery technique: how we do it
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DOI：
10.23736/s0021-9509.21.11825-7
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发表时间：
2021-08-01
影响因子：
1.4
通讯作者：
Safi, Hazim J.
中科院分区：
文献类型：
--
作者：
Tanaka, Akiko;Estrera, Anthony L.;Safi, Hazim J.
自从现代治疗胸腹主动脉瘤 (TAAA) 的原则确立以来，已经过去了四十多年。 TAAA 修复的历史性挑战以多器官保护为代表，并将继续如此。诸脏腑之中。脊髓仍然是最重要和最脆弱的部分之一。我们描述了当前开放 II 级 TAAA 修复技术，包括以下主题：麻醉。术中监测、皮肤切口、TAAA 暴露、左心搭桥、移植物置换技术、肋间动脉再接、内脏/肾动脉重建和术后护理。我们采用脑脊液引流、远端主动脉灌注、轻度被动低温、序贯钳夹。所有病例均使用滚压泵进行内脏和肾脏灌注，以实现多器官保护。运动诱发电位和体感诱发电位均用于指导肋间动脉再附着的进行。我们的研究小组证明，辅助药物的使用已将 I 级 TAAA 后的总体脊髓缺血率从 15% 降低至 2% 以下，将 II 级 TAAA 后的总体脊髓缺血率从 33%（“钳夹即走”时代钳夹时间超过 40 分钟时为 50%）降低至 4% 以下。当前 TAAA 辅助修复的标准做法改善了结果，特别是在脊髓缺血方面。
More than four decades have passed since the modern principals to treat thoracoabdominal aortic aneurysm (TAAA) have been established. The historical challenges in repair of TAAA are represented by - and continue to be - multiorgan protection. Among all organs. the spinal cord remains one of the most vital and vulnerable. We described our current techniques of open extent II TAAA repair, including the following topics: anesthesia. intraoperative monitoring, skin incision, exposure of the TAAA, left heart bypass, graft replacement technique, intercostal artery reattachment, visceral/renal artery reconstnictions, and postoperative care. We use cerebrospinal fluid drainage, distal aortic perfusion, mild passive hypothermia, sequential clamping. and visceral and renal perfusion using roller pump in all the cases for multiorgan protection. Both motor-evoked potentials and somatosensory-evoked potentials ere used to guide the conduct of intercostal artery reattachment. Our group demonstrated that the use of adjuncts has reduced the overall spinal cord ischemia rate after Extent I TAAA from 15% to less than 2% and after Extent II TAAA from 33% (50% with clamp time exceeding 40 minutes in "clamp and go" era) to less than 4%. The current standard practice of TAAA repair with adjuncts has improved outcomes, especially regarding spinal cord ischemia.