Selder J, Algra S, Evens F, Freund M, Strengers J, Schouten T, Haas F
Cardio Thoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Thorac Cardiovasc Surg. 2010 Feb;58(1):17-22. doi: 10.1055/s-0029-1186242. Epub 2010 Jan 13.
Because deep hypothermic circulatory arrest (DHCA) carries a risk for neurological damage, antegrade cerebral perfusion (ACP) is used increasingly for aortic arch surgery in infants. We assessed the short-term effects of minimal DHCA (< 30 minutes) versus prolonged DHCA (> 30 minutes) during biventricular aortic arch reconstruction.
Twenty-six infants (< 3 months of age) who had undergone aortic arch reconstruction were retrospectively analyzed: 15 infants without DHCA (group A) and 11 infants with DHCA (group B). Group B was further divided into < 30 minutes DHCA (group B1, n = 6), and >or= 30 minutes DHCA (group B2, n = 5). Additionally, minimal DHCA (group A + B1) was compared to prolonged DHCA (group B2).
In the minimal DHCA group (A + B1), 29 % of the patients had a postoperative adverse event, compared to 80 % in the prolonged DHCA group (B2) ( P < 0.05). Average length of stay in hospital was 25 days shorter for the minimal DHCA group (15 days versus 40 days, P < 0.01).
Minimal DHCA results in fewer adverse events and a reduced length of stay, compared with prolonged DHCA. Therefore, during aortic arch surgery in infants, DHCA should be minimized by using antegrade cerebral perfusion.
由于深低温停循环（DHCA）存在神经损伤风险，顺行性脑灌注（ACP）在婴儿主动脉弓手术中的应用日益增多。我们评估了在双心室主动脉弓重建术中，短时间DHCA（<30分钟）与长时间DHCA（>30分钟）的短期效果。
对26例接受主动脉弓重建术的婴儿（<3个月龄）进行回顾性分析：15例未行DHCA（A组），11例接受DHCA（B组）。B组进一步分为DHCA时间<30分钟（B1组，n = 6）和≥30分钟（B2组，n = 5）。此外，将短时间DHCA组（A + B1）与长时间DHCA组（B2）进行比较。
短时间DHCA组（A + B1）术后不良事件发生率为29%，而长时间DHCA组（B2）为80%（P < 0.05）。短时间DHCA组平均住院时间缩短25天（15天对40天，P < 0.01）。
与长时间DHCA相比，短时间DHCA导致的不良事件更少，住院时间更短。因此，在婴儿主动脉弓手术中，应通过顺行性脑灌注尽量减少DHCA的使用时间。
