Minatoya Kenji, Ogino Hitoshi, Matsuda Hitoshi, Sasaki Hiroaki
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan.
Interact Cardiovasc Thorac Surg. 2008 Dec;7(6):951-3. doi: 10.1510/icvts.2007.171546. Epub 2008 Jul 17.
There is no agreement at present as to which is the optimal site for artery cannulation for cardiopulmonary bypass in repair of acute aortic dissection (AAD). We have employed right axillary artery cannulation (RAAC) in combination with femoral artery cannulation to overcome the drawbacks of single cannulation. From January 2000 to August 2006, 88 patients underwent emergency surgical repair of the aortic arch (mean age 65+/-13 years, 37 men) for AAD. All operations were performed under hypothermic circulatory arrest with antegrade selective cerebral perfusion. Preoperatively, nine patients were in shock and 18 patients showed malperfusion. The average duration of circulatory arrest was 52+/-17 min and that of myocardial ischemia was 135+/-53 min. Total aortic arch replacement was done in 47 patients and hemiarch aortic replacement in 41. The hospital mortality rate was 2.3% (2 of 88); the fatal cases were among those who were in shock preoperatively. The perioperative stroke rate was 5.7% (5 of 88). The hospital mortality rate of the 25 patients with preoperative malperfusion was 4.0% (1 of 25); the fatal case had coronary malperfusion. Our approach for AAD was associated with a low mortality even in patients with malperfusion.
目前对于急性主动脉夹层（AAD）修复术中体外循环动脉插管的最佳部位尚无定论。我们采用右腋动脉插管（RAAC）联合股动脉插管来克服单一插管的缺点。2000年1月至2006年8月，88例患者因AAD接受了主动脉弓急诊手术修复（平均年龄65±13岁，男性37例）。所有手术均在低温循环停搏及顺行性选择性脑灌注下进行。术前，9例患者处于休克状态，18例患者出现灌注不良。循环停搏的平均持续时间为52±17分钟，心肌缺血的平均持续时间为135±53分钟。47例行全主动脉弓置换术，41例行半弓主动脉置换术。医院死亡率为2.3%（88例中有2例）；死亡病例为术前处于休克状态的患者。围手术期卒中发生率为5.7%（88例中有5例）。25例术前有灌注不良的患者的医院死亡率为4.0%（25例中有1例）；死亡病例存在冠状动脉灌注不良。我们治疗AAD的方法即使在有灌注不良的患者中也具有较低的死亡率。
