Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University Hospital Essen, Essen, Germany.
Eur J Cardiothorac Surg. 2010 Oct;38(4):507-9. doi: 10.1016/j.ejcts.2010.02.010. Epub 2010 Mar 23.
During hypothermic circulatory arrest (HCA), a briefly visible descending aorta is exposed, enabling direct vision to the surgeon. This study evaluated the impact of angioscopy on arch and descending aortic surgery for type A aortic dissection (AD). From December 2007 to March 2009, a flexible bronchovideoscope was used in 21 patients to assure true lumen (TL) positioning of the arterial cannula during open vision aortic cannulation (OVAC; nine of 21 cases) and to inspect the arch and descending aorta for re-entries, guide wire position and target zone for hybrid stent graft (SG) landing (20 of 21 cases). In OVAC, angioscopy secured positioning of the arterial cannula within the TL requiring additional 10-15s of cerebral ischaemia. In 10 of 21 cases, no additional re-entries were found, thus obviating arch replacement in 2 of 21 and stent grafting in 8 of 21. In 11 of 21 cases, SG deployment was guided to the target zone, in three cases incomplete unfolding initiated balloon dilatation. Angioscopy has become an indispensable tool for decision making in AD to apply OVAC, downstream stent grafting and landing zone control with the ability to indicate ballooning at neglectable time requirements during HCA.
在低温循环停止（HCA）期间，短暂可见的降主动脉暴露，使外科医生能够直接观察。本研究评估了血管镜对 A 型主动脉夹层（AD）弓部和降主动脉手术的影响。2007 年 12 月至 2009 年 3 月，在 21 例患者中使用柔性支气管镜，以确保在直视主动脉插管（OVAC；21 例中的 9 例）中动脉插管位于真腔（TL），并检查弓部和降主动脉的再入口、导丝位置和杂交支架移植物（SG）着陆的目标区（21 例中的 20 例）。在 OVAC 中，血管镜可确保动脉插管位于 TL 内，需要额外的 10-15 秒脑缺血。在 21 例中的 10 例中，未发现其他再入口，因此避免了 21 例中的 2 例弓部置换和 21 例中的 8 例支架置入。在 21 例中的 11 例中，SG 部署被引导到目标区，在 3 例中，不完全展开启动了球囊扩张。血管镜已成为 AD 中应用 OVAC、下游支架置入和着陆区控制决策的不可或缺的工具，具有在 HCA 期间以可忽略的时间要求指示球囊扩张的能力。
