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低温停循环（DHCA），并且与许多术后并发症相关。如果能够在常温条件下实现体外循环而不发生心脏骤停，则预期手术结局会有所改善。本研究的目的是阐明这种置换手术的最佳条件。[方法]用Beagle犬监测心电图（ECG）、左房压（LVEF）、升主动脉根压（Ao root Pre）和股动脉压（FAP）。在开始F-F旁路后，夹闭升主动脉（Asc Ao）。持续监测直至动物脱离体外循环（ECC）。将动物分为两组：经主动脉根部进行冠状动脉灌注（2 ml/min/kg）的动物和不进行冠状动脉灌注的动物。[结果] 1）两组受试者在主动脉阻断120 min内均保持心脏活动。血流动力学保持稳定，即使在夹子被释放，并脱离体外循环是直截了当的。（2）无冠脉灌注组左房压力于术后80 min开始升高，术后90 min达到峰值，为15 mmHg。[结论]升主动脉夹闭作为主动脉弓置换术的辅助技术，在常温下无心跳骤停是可行的，同时冠状动脉灌注是维持血流动力学稳定的重要手段。通过本报告的制作，我们找到了以下有关逆灌效应的心电图和灌注变化的相关文献。

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.