Wang Li-Ming, Chen Xin, Shi Kai-Hu, Xu Ming, Jiang Ying-Shuo, Xiao Li-Qiong, Zhao Hai-Peng, Liu Pei-Sheng, Wang Rui, Zhen Ling
Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China.
Zhonghua Yi Xue Za Zhi. 2009 Jan 6;89(1):45-7.
To summarize the surgical experience of aortic arch operation under deep hypothermic circulatory arrest.
22 patients suffering from aortic dissection or descending aorta aneurysm with the involvement of aortic arch received operation under deep hypothermic circulatory arrest. Eight patients underwent ascending aorta and partial aortic arch replacement, one patient received aortic root, ascending aorta, and partial aortic arch replacement, 2 patients received ascending aorta and total arch replacement, 2 patients received aortic valve replacement plus ascending aorta and partial aortic arch replacement, 8 patients underwent ascending aorta and total arch replacement plus elephant trunk technique (stunted elephant trunk used in 6 cases), and 1 patient received left partial aortic arch and descending aorta replacement. Coronary artery bypass grafting was performed concomitantly in 4 cases.
Three patients died peri-operatively with a mortality rate of 13.6%. One patient had aortic dissection rupture before operation leading to cardiac tamponade, acute inferior myocardial infarction, and cardiac arrest. This patient received operation while resuscitation. After operation, the patient had severe right heart failure and died 16 hours later. One patient had bleeding and multi-organ failure, and died 3 days later. The third patient, with acute aortic dissection did not awake after operation, had pulmonary infection and multi-organ failure, and died 39 days later. Re-thoracotomy for bleeding was required in 3 cases; delayed awareness occurred in 3 cases; and 2 cases had renal failure after operation.
Aortic arch operation includes partial aortic arch replacement, total arch replacement, and total arch replacement with elephant trunk technique. The operation procedure is selected according to the primary lesion and how aortic arch has been affected. Deep hypothermic circulatory arrest with selective cerebral perfusion facilitates complicated aortic arch operation, resulting in a reduction of mortality and morbidity for arch aneurysms or dissection.
总结深低温停循环下主动脉弓手术的经验。
22例主动脉夹层或降主动脉瘤累及主动脉弓的患者接受了深低温停循环下的手术。8例行升主动脉及部分主动脉弓置换术，1例行主动脉根部、升主动脉及部分主动脉弓置换术，2例行升主动脉及全弓置换术，2例行主动脉瓣置换术加升主动脉及部分主动脉弓置换术，8例行升主动脉及全弓置换术加象鼻技术（6例采用短象鼻技术），1例行左半主动脉弓及降主动脉置换术。4例同期行冠状动脉搭桥术。
围手术期死亡3例，死亡率为13.6%。1例患者术前主动脉夹层破裂导致心包填塞、急性下壁心肌梗死和心脏骤停。该患者在复苏过程中接受手术。术后患者出现严重右心衰竭，16小时后死亡。1例患者出现出血和多器官功能衰竭，3天后死亡。第3例急性主动脉夹层患者术后未苏醒，发生肺部感染和多器官功能衰竭，39天后死亡。3例因出血需再次开胸；3例出现延迟苏醒；2例术后出现肾衰竭。
主动脉弓手术包括部分主动脉弓置换术、全弓置换术和带象鼻技术的全弓置换术。手术方式根据原发病变及主动脉弓受累情况选择。深低温停循环加选择性脑灌注有助于复杂的主动脉弓手术，降低主动脉瘤或夹层的死亡率和发病率。
