Spielvogel David, Etz Christian D, Silovitz Daniel, Lansman Steven L, Griepp Randall B
Section of Cardiothoracic Surgery, New York College of Medicine, Westchester Medical Center, Valhalla 10595, USA.
Ann Thorac Surg. 2007 Feb;83(2):S791-5; discussion S824-31. doi: 10.1016/j.athoracsur.2006.11.015.
The purpose of this study was to review the results of aortic arch replacement using a trifurcated arch graft in conjunction with hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SCP).
One hundred fifty consecutive patients (91 male; mean age, 63 +/- 14 years; range, 20 to 87) had aortic arch replacement using a trifurcated arch graft and HCA/SCP from September 1999 to December 2005. The axillary artery was used for cannulation; a trifurcated graft was sewn to the arch vessels during a short interval of HCA; SCP was utilized through the trifurcation graft during the proximal and distal arch repair, and then the trifurcation graft was sewn to the arch graft. Fifty-five patients had chronic dissection; 48 had atherosclerotic and 29 had degenerative aneurysms; 74 had undergone previous cardiac surgery. Isolated arch reconstruction was undertaken in 38 patients: concomitant procedures included ascending aortic replacement in 74; ascending aorta and root replacement in 21; descending replacement in 4, and coronary artery bypass grafting in 36. An elephant trunk was used in 144, but distal to the left subclavian artery in only 87; in 34, it was distal to the left carotid, in 9, it was between the brachiocephalic and left carotid, and in 18, it was proximal to all arch branches. Mean HCA duration was 31.1 +/- 6.5 minutes; SCP lasted 66.6 +/- 21.0 minutes, at a mean temperature of 15.8 +/- 2.1 degrees C.
Adverse outcome occurred in 13 of 150 patients (8.7%): there were 7 hospital deaths and 6 permanent strokes. Temporary neurologic dysfunction was seen in only 7 patients, and renal failure was transient in 9 patients requiring dialysis.
The use of a trifurcated arch graft with HCA and SCP is a safe and versatile technique for repair of arch aneurysms.
本研究的目的是回顾使用三分叉弓移植物结合低温循环停止（HCA）和选择性顺行脑灌注（SCP）进行主动脉弓置换的结果。
1999年9月至2005年12月，连续150例患者（91例男性；平均年龄63±14岁；范围20至87岁）使用三分叉弓移植物和HCA/SCP进行主动脉弓置换。腋动脉用于插管；在短暂的HCA期间，将三分叉移植物缝合到弓血管上；在近端和远端弓修复期间，通过三分叉移植物进行SCP，然后将三分叉移植物缝合到弓移植物上。55例患者有慢性夹层；48例有动脉粥样硬化，29例有退行性动脉瘤；74例曾接受过心脏手术。38例患者进行了孤立的弓重建：同期手术包括升主动脉置换74例；升主动脉和主动脉根部置换21例；降主动脉置换4例，冠状动脉旁路移植36例。144例使用了象鼻技术，但仅87例在左锁骨下动脉远端；34例在左颈动脉远端，9例在头臂干和左颈动脉之间，18例在所有弓分支近端。平均HCA持续时间为31.1±6.5分钟；SCP持续66.6±21.0分钟，平均温度为15.8±2.1摄氏度。
150例患者中有13例（8.7%）出现不良结局：7例住院死亡，6例永久性卒中。仅7例患者出现短暂性神经功能障碍，9例需要透析的患者肾功能衰竭为短暂性。
使用三分叉弓移植物结合HCA和SCP是一种安全且通用的修复弓动脉瘤的技术。
