Sanioglu Soner, Sokullu Onur, Arslan I Yucesin, Sargin Murat, Yilmaz Mehmet, Ozay Batuhan, Tokoz Hamdi, Bilgen Fuat
Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Heart Surg Forum. 2009 Apr;12(2):E65-9. doi: 10.1532/HSF98.20091002.
Unilateral antegrade cerebral perfusion can be performed with minimal manipulations to arch arteries, but whether it provides adequate brain perfusion remains unclear. Some authors believe that this technique can be inadequate without deep hypothermia. We investigated the reliability of unilateral cerebral perfusion at 22 degrees C hypothermia and the advantages of avoiding deep hypothermia.
Study participants were 55 patients who underwent surgery with unilateral cerebral perfusion. Patients were divided into 2 groups; 18 patients underwent surgery at 16 degrees C hypothermia (group I) and 37 patients at 22 degrees C hypothermia (group II). The mean age of the patients was 59 +/- 10 years in group I and 55 +/- 14 years in group II. Supracoronary ascending aorta replacement was performed in 25 and hemiarch replacement in 15 patients. Nine patients underwent surgery for a Bentall procedure. Total arch replacement was performed in 4 patients and total thoracic aorta replacement in 2 patients.
The hospital mortality was 11% in group I and 5.4% in group II (P = .59). Transient neurologic deficits were not detected in any of the patients. The rate of permanent neurologic deficits was 5.9% in group I and 2.8% in group II (P = .54). Although mean aortic cross-clamp and antegrade cerebral perfusion times were not significantly different, mean cardiopulmonary bypass time was longer in group I than group II (174 +/- 38 vs 142 +/- 37 minutes, P = .005). Postoperative bleeding, blood product usage, serum creatinine and hepatic enzyme level changes, inotrope usage, and arrhythmia occurrence were not different between the 2 groups. Mean mechanical ventilation time was longer in group I than group II (24 +/- 17 vs 16 +/- 6 hours, P = .02).
Unilateral antegrade cerebral perfusion at 22 degrees C systemic hypothermia appears to be safe and reliable for brain protection. Advantages of this technique are avoidance of deep hypothermia and reduced cardiopulmonary bypass and mechanical ventilation times in patients undergoing aortic surgery.
单侧顺行性脑灌注可通过对主动脉弓进行最少的操作来完成，但它是否能提供足够的脑灌注仍不清楚。一些作者认为，若无深度低温，该技术可能不足。我们研究了22℃低温下单侧脑灌注的可靠性以及避免深度低温的优势。
研究参与者为55例行单侧脑灌注手术的患者。患者分为2组；18例患者在16℃低温下进行手术（I组），37例患者在22℃低温下进行手术（II组）。I组患者的平均年龄为59±10岁，II组为55±14岁。25例患者行冠状动脉上方升主动脉置换术，15例患者行半弓置换术。9例患者接受Bentall手术。4例患者行全弓置换术，2例患者行全胸主动脉置换术。
I组的医院死亡率为11%，II组为5.4%（P = 0.59）。所有患者均未检测到短暂性神经功能缺损。I组永久性神经功能缺损率为5.9%，II组为2.8%（P = 0.54）。虽然平均主动脉阻断时间和顺行性脑灌注时间无显著差异，但I组的平均体外循环时间比II组长（174±38 vs 142±37分钟，P = 0.005）。两组之间术后出血、血液制品使用、血清肌酐和肝酶水平变化、血管活性药物使用及心律失常发生率无差异。I组的平均机械通气时间比II组长（24±17 vs 16±6小时，P = 0.02）。
22℃全身低温下单侧顺行性脑灌注似乎对脑保护是安全可靠的。该技术的优势在于避免深度低温，并减少主动脉手术患者的体外循环和机械通气时间。
