无名动脉插管与弓部手术中的旁路移植。

Cannulation of the innominate artery with a side graft in arch surgery.

机构信息

Cardiac Surgery Division, Beijing Institute of Heart, Lung and Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China.

出版信息

Ann Thorac Surg. 2010 Mar;89(3):800-3. doi: 10.1016/j.athoracsur.2009.12.005.

DOI:10.1016/j.athoracsur.2009.12.005

PMID:20172131

Abstract

BACKGROUND

The purpose of this study was to examine the safety and efficacy of cannulation of the innominate artery with a side graft in arch surgery.

METHODS

Between January 2004 and March 2009, 46 patients received arch surgery under hypothermia circulatory arrest (HCA) and hemispheric antegrade cerebral perfusion (HACP). There were 36 men and 10 women with an average age of 48.0 +/- 12.8 years. Thirty-four patients had type A aortic dissection. Four patients had type B aortic dissection. The remaining 8 patients had aortic aneurysm involving the ascending aorta and arch. The innominate artery was free of diseases in all patients. The diameter of the innominate artery was 12.1 +/- 1.6 mm (range, 9 to 16 mm). An 8-mm vascular graft, which was anastomosed to the innominate artery in an end-to-side manner, was used for arterial cannulation. Ascending aorta and arch replacement in combination with open stent-graft implantation was conducted in 42 patients. Four patients received open stent-graft implantation through the aortic arch only.

RESULTS

The aortic cross-clamp time was 87.2 +/- 36.0 minutes. The lowest nasopharyngeal temperature was 21.0 +/- 3.6 degrees C. The HCA and the HACP time was 29.6 +/- 14.0 minutes. The HACP flow was 8.3 +/- 2.3 mL x kg(-1) x min(-1). Five patients (10.9%) had temporary postoperative neurologic dysfunction. There was no permanent neurologic dysfunction. Three patients died within 30 days postoperatively, and the 1-month mortality rate was 6.5%. All of the surviving patients were followed for 24.9 +/- 18.0 months (range, 1 to 63). There were no deaths or severe complications during the follow-up.

CONCLUSIONS

Cannulation of the innominate artery with a side graft is safe and effective in arch surgery.

摘要

背景

本研究旨在探讨在低温循环停止（HCA）和半球前向脑灌注（HACP）下使用旁路移植物进行无名动脉插管的安全性和有效性。

方法

2004 年 1 月至 2009 年 3 月，46 例患者在 HCA 和 HACP 下接受弓部手术。男性 36 例，女性 10 例，平均年龄 48.0±12.8 岁。34 例患者为 A 型主动脉夹层，4 例患者为 B 型主动脉夹层，其余 8 例患者为累及升主动脉和弓部的主动脉瘤。所有患者无名动脉均无病变，无名动脉直径 12.1±1.6mm（范围 9~16mm）。使用 8mm 血管移植物行端侧吻合，用于动脉插管。42 例患者行升主动脉和弓部置换术，并结合开放支架植入术，4 例患者仅通过主动脉弓行开放支架植入术。

结果

主动脉阻断时间 87.2±36.0 分钟，鼻咽温度最低 21.0±3.6°C，HCA 和 HACP 时间 29.6±14.0 分钟，HACP 流量 8.3±2.3mL·kg-1·min-1。5 例（10.9%）患者术后出现短暂性神经功能障碍，无永久性神经功能障碍。术后 30 天内死亡 3 例，1 个月死亡率为 6.5%。所有存活患者均随访 24.9±18.0 个月（1~63 个月），随访期间无死亡或严重并发症。