Ogino Hitoshi, Ando Motomi, Sasaki Hiroaki, Minatoya Kenji
Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
Eur J Cardiothorac Surg. 2006 Feb;29(2):255-7. doi: 10.1016/j.ejcts.2005.10.040. Epub 2006 Jan 11.
A total of 120 patients having arch to distal arch aneurysm with downstream extension underwent total arch replacement, with individual arch-vessel reconstruction through median sternotomy using a novel "stepwise" distal aortic anastomosis. Cardiopulmonary bypass was established by cannulating the right axillary artery and the ascending aorta or femoral artery. Hypothermia was at 22-28 degrees C. Through the aneurysm, the descending aorta was divided. Distal anastomosis using the stepwise technique was performed; a tube graft of length 7-12 cm was inserted into the descending aorta and anastomosed by running suture. The distal end of the inserted graft was extracted, and a further four-branched arch graft was joined to it. Selective cerebral perfusion was used for cerebral safety during arch repair. There were three hospital deaths (2.5%). Two patients (1.7%) developed permanent neurological dysfunction and three patients (2.5%) suffered transient cerebral deficits. Three patients (2.5%) required reentry for postoperative bleeding although in none of them bleeding was from the distal anastomosis site with the stepwise technique. Stepwise anastomosis is a useful and secure alternative for distal anastomosis in total arch replacement for arch to distal arch aneurysms with distal extension.
共有120例患有从主动脉弓至远段主动脉弓动脉瘤并伴有下游延伸的患者接受了全弓置换术，通过正中胸骨切开术采用一种新颖的“逐步”远段主动脉吻合技术进行了个体化的弓血管重建。通过右腋动脉和升主动脉或股动脉插管建立体外循环。体温降至22 - 28摄氏度。经动脉瘤将降主动脉离断。采用逐步技术进行远段吻合；将一段7 - 12厘米长的人工血管插入降主动脉并连续缝合进行吻合。将插入的人工血管远端引出，再连接一个四分支的弓部人工血管。在弓部修复过程中采用选择性脑灌注以保障脑安全。有3例患者在医院死亡（2.5%）。2例患者（1.7%）出现永久性神经功能障碍，3例患者（2.5%）出现短暂性脑功能缺损。3例患者（2.5%）因术后出血需要再次开胸，不过采用逐步技术时，这些患者中无一例出血来自远段吻合部位。逐步吻合术是全弓置换治疗伴有远段延伸的从主动脉弓至远段主动脉弓动脉瘤时进行远段吻合的一种有用且安全的替代方法。
