A study on an auxiliary technique for arch replacement under normothermic conditions without cardiac arrest

主动脉弓置换术需要深度低温循环停搏（DHCA），并伴有许多术后并发症。如果能在常温条件下实现体外循环而不发生心脏骤停，手术效果将得到改善。本研究的目的是阐明这种替代手术的最佳条件。[方法]监测比格犬心电图（ECG）、左房压（LAP）、升主动脉根压（Ao root Pre）和股动脉压（FAP）。F-F分流术开始后，夹紧升主动脉。持续监测，直到动物从体外循环（ECC）断奶。动物分为经主动脉根部冠脉灌注组（2 ml/min/kg）和无冠脉灌注组。[结果]1)两组受试者在主动脉夹持术120分钟内均保持心脏活动。即使在松开钳后，血流动力学仍然保持稳定，并且直接脱离体外循环。2)无冠状动脉灌注组左房压在夹持后80分钟开始升高，在夹持后90分钟达到峰值15 mmHg。【结论】作为动脉弓置换术中的辅助技术，在常温条件下无心脏骤停的情况下，升主动脉夹持是可行的，同时冠状动脉灌注对维持血流动力学稳定具有重要意义。通过本报告，我们发现了如下的相关文献，关于心电图和灌注改变对逆行灌注效果的影响。

Aortic arch replacement requires deep hypothermic circulatory arrest(DHCA) and is associated with many postoperative complications. Improved surgical outcome would be anticipated if extracorporeal circulation could be achieved under normothermic conditions without cardiac arrest. The objective of the present study was to clarify the optimal conditions for such replacement surgery.[Methods]Electrocardiography(ECG), left atrial pressure(LAP), ascending aortic root pressure(Ao root Pre) and femoral artery pressure(FAP) were monitored in beagle dogs. After initiation of F-F bypass, the ascending aorta(Asc Ao) was clamped. Monitoring was continued until animals were weaned from extracorporeal circulation(ECC). Animals were divided into two groups: those with coronary perfusion via the aortic root(2 ml/min/kg), and those without coronary perfusion. [Results] 1)In all subjects in both groups, cardiac activity was maintained throughout 120 minutes of aortic clamping. Hemodynamics remained stable even after the clamp was released, and weaning from extracorporeal circulation was straightfonvard. 2)In the group without coronary perfusion, left atrial pressure started to increase starting 80 minutes after clamping, reaching a peak of 15 mmHg at 90 minutes after clamping. [Conclusions]As an auxiliary technique during arch replacement, clamping of the ascending aorta is possible under normothermic conditions without cardiac arrest, and concurrent coronary perfusion is important for maintaining hemodynamic stability. We find related documents like the following else,about against an electrocardiography and perfusion change for retrograde perfusioneffect by this report making.