Ehrlich M, Grabenwöger M, Luckner D, Simon P, Laufer G, Wolner E, Havel M
Clinic of Surgery, Department of Cardio-Thoracic Surgery, University of Vienna, Austria.
J Cardiovasc Surg (Torino). 1996 Dec;37(6 Suppl 1):63-4.
Since the first successful replacement of the aortic arch with perfusion of the head, various methods have been employed to preserve cerebral function during aneurysm operations. Although deep hypothermia was used for surgery of the aortic arch, as early as 1963, the introduction of prolonged circulatory arrest has simplified replacements of the aortic arch. Between October 1990 and September 1993, 69 patients underwent aortic arch replacement for aneurysmal disease at the Dept. of Cardio-Thoracic Surg., University of Vienna. 52 patients had an acute dissection Type A, 17 patients were operated on electively. The patients age (48 male, 21 female) ranged between 16 and 81 years. Primary diagnosis was hypertension (n=44), marfan (n=14), unknown (n=10) and trauma (n=1). Total cardiopulmonary bypass was established via femoral artery cannulation. All patients received Cortison and Thiopental for added cerebral protection. Deep hypothermia (12 degrees C), confirmed by 0-EEG, and circulatory arrest were induced in all patients. The aneurysm was opened longitudinally and a full thickness single patch or "island" of aortic wall, containing the origins of the three arch vessels, was constructed and anastomosed in a continuous fashion to an albumin coated graft. 68 patients survived the operation (intraoperative mortality 1%). The 30-day mortality was 23% (n=16). Twelve patients died of multiorgan failure, two patients of a stroke and two due to myocardial infarction. The mean cerebral circulatory arrest time was 32 minutes (range 11-61 min.). Our experience with aortic arch replacements using profound hypothermia and circulatory arrest supports our contention, that it is the method of choice in this very difficult surgical field.
自从首次成功进行带头部灌注的主动脉弓置换以来，在动脉瘤手术期间已采用了各种方法来保护脑功能。尽管早在1963年就已将深低温用于主动脉弓手术，但延长循环阻断技术的引入简化了主动脉弓置换术。1990年10月至1993年9月期间，维也纳大学心胸外科有69例患者因动脉瘤性疾病接受了主动脉弓置换术。52例患者为急性A型夹层，17例为择期手术。患者年龄（48例男性，21例女性）在16岁至81岁之间。主要诊断为高血压（n = 44）、马凡综合征（n = 14）、病因不明（n = 10）和创伤（n = 1）。通过股动脉插管建立全身体外循环。所有患者均接受皮质类固醇和硫喷妥钠以增强脑保护作用。所有患者均诱导深低温（12℃），经脑电图证实为等电位脑电图，并进行循环阻断。纵向切开动脉瘤，构建一块包含三根弓状血管起源的全层单补片或主动脉壁“岛”，并以连续方式与白蛋白涂层移植物吻合。68例患者手术存活（术中死亡率1%）。30天死亡率为23%（n = 16）。12例患者死于多器官功能衰竭，2例死于中风，2例死于心肌梗死。平均脑循环阻断时间为32分钟（范围11 - 61分钟）。我们使用深低温和循环阻断进行主动脉弓置换的经验支持我们的观点，即这是这个极具挑战性的手术领域的首选方法。
