Borger M A, Taylor R L, Weisel R D, Kulkarni G, Benaroia M, Rao V, Cohen G, Fedorko L, Feindel C M
Division of Cardiovascular Surgery, The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 1999 Oct;118(4):740-5. doi: 10.1016/S0022-5223(99)70021-8.
Cerebral emboli occur during cardiopulmonary bypass and are a principal cause of postoperative neurologic dysfunction. We hypothesized that arterial cannulation of the distal aortic arch, with placement of the cannula tip beyond the left subclavian artery, will result in fewer cerebral microemboli than conventional cannulation of the ascending aorta.
Patients undergoing coronary bypass surgery with a single crossclamp technique were randomized to receive cannulation of the distal aortic arch (n = 17) or standard cannulation of the ascending aorta (control group, n = 17). Trendelenburg positioning was used whenever possible. Cerebral emboli were quantified by continuous transcranial Doppler monitoring of the middle cerebral artery.
Baseline demographics were similar for the 2 groups of patients, including cardiopulmonary bypass and crossclamp times. Cerebral microemboli were detected during cardiopulmonary bypass in all patients, with a range of 17 to 627 emboli. The total number of detected emboli was lower in the arch cannulation group (152 +/- 33, mean +/- standard error of the mean) than in the conventional cannulation group (249 +/- 35, P =.04). Embolization rates were lower in distal arch patients than in control patients during cardiopulmonary bypass (2.0 +/- 0.3 vs 4.2 +/- 0.9 per minute, respectively, P =.03). Reduction in cerebral emboli by distal arch cannulation was most pronounced during perfusionist interventions.
Cannulation of the distal aortic arch results in less cerebral microembolism than conventional cannulation of the ascending aorta. Provided it is performed safely, distal arch cannulation may be an important surgical option for patients with severe atherosclerosis of the ascending aorta.
心肺转流期间会发生脑栓塞，这是术后神经功能障碍的主要原因。我们假设，在主动脉弓远端进行动脉插管，使插管尖端置于左锁骨下动脉之外，与传统的升主动脉插管相比，将导致更少的脑微栓塞。
采用单钳夹技术进行冠状动脉搭桥手术的患者被随机分为接受主动脉弓远端插管组（n = 17）或升主动脉标准插管组（对照组，n = 17）。尽可能采用头低脚高位。通过对大脑中动脉进行连续经颅多普勒监测来量化脑栓塞。
两组患者的基线人口统计学特征相似，包括心肺转流时间和钳夹时间。所有患者在心肺转流期间均检测到脑微栓塞，栓塞数量范围为17至627个。主动脉弓插管组检测到的栓塞总数（152±33，均值±均值标准误）低于传统插管组（249±35，P = 0.04）。在心肺转流期间，主动脉弓远端患者的栓塞率低于对照组患者（分别为每分钟2.0±0.3次和4.2±0.9次，P = 0.03）。在灌注师干预期间，通过主动脉弓远端插管减少脑栓塞最为明显。
与传统的升主动脉插管相比，主动脉弓远端插管导致的脑微栓塞更少。如果操作安全，主动脉弓远端插管可能是升主动脉严重动脉粥样硬化患者的重要手术选择。
