Kikuchi Y, Sakurada T, Hirano T, Suzuki M, Kusajima K
Section of Cardiovascular Surgery, National Obihiro Hospital, Obihiro, Japan.
Kyobu Geka. 2002 Apr;55(4):309-13.
Between October, 1991, and October, 2001, 60 patients underwent aortic arch replacement with or without an aortic arch branched graft for atherosclerotic arch aneurysms. Their mean age was 70.1 +/- 8.6 years. Eight (13.3%) patients were operated on an emergency basis because of rupture or impending rupture of aneurysms. All operations were performed with hypothermic extracorporeal circulation. Selective cerebral perfusion for cerebral protection during aortic arch repair and systemic circulatory arrest during distal graft anastomosis was used in 56 patients. Mean selective cerebral perfusion time was 86.1 +/- 12.1 minutes. A total of 14 concomitant procedures were done. Overall in-hospital mortality was 3.3%. Postoperative temporary and permanent neurologic dysfunction were 1.6% and 1.6%. Long-term follow-up was 100% complete. There were 6 late deaths with the cumulative survival rate was 74.6 +/- 8.8%. A subsequent aortic operation was necessary for the treatment of an aortic abnormality distal to the arch in 6 patients. Reoperation free rate was 85.2 +/- 5.8%. In conclusion, cerebral protective effect of antegrade selective cerebral perfusion and total arch replacement with an aortic arch branched graft could substantially reduce in-hospital mortality and postoperative neurologic dysfunction and a satisfactory long-term results could be obtain in patients with atherosclerotic arch aneurysms.
1991年10月至2001年10月期间，60例患者因动脉粥样硬化性主动脉弓瘤接受了主动脉弓置换术，部分患者同时植入了主动脉弓分支移植物。他们的平均年龄为70.1±8.6岁。8例（13.3%）患者因动脉瘤破裂或即将破裂而接受急诊手术。所有手术均在低温体外循环下进行。56例患者在主动脉弓修复期间采用选择性脑灌注进行脑保护，在远端移植物吻合期间采用全身循环停止。平均选择性脑灌注时间为86.1±12.1分钟。共进行了14项同期手术。总体住院死亡率为3.3%。术后短暂性和永久性神经功能障碍分别为1.6%和1.6%。长期随访的完成率为100%。有6例晚期死亡，累积生存率为74.6±8.8%。6例患者因治疗主动脉弓远端的主动脉异常而需要再次进行主动脉手术。无再次手术率为85.2±5.8%。总之，顺行性选择性脑灌注和主动脉弓分支移植物全弓置换的脑保护作用可显著降低住院死亡率和术后神经功能障碍，动脉粥样硬化性主动脉弓瘤患者可获得满意的长期结果。
