Division of Cardiovascular Surgery, the Texas Heart Institute at St. Luke's Episcopal Hospital, and Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Ann Thorac Surg. 2010 Apr;89(4):e31-2. doi: 10.1016/j.athoracsur.2010.01.054.
In patients who have undergone coronary artery bypass with a left internal thoracic artery graft, clamping the aorta proximal to the left subclavian artery during descending thoracic and thoracoabdominal aortic aneurysm repair can precipitate major cardiac complications. Many centers use hypothermic circulatory arrest to obviate the need for aortic clamping in these cases. Herein, we describe the successful application of an alternative approach to this problem: performing left carotid-subclavian bypass before aneurysm repair. This technique allows aortic cross-clamping proximal to the left subclavian artery, prevents major intraoperative cardiac complications, and avoids cardiopulmonary bypass and hypothermic circulatory arrest.
在接受左内乳动脉搭桥术的冠状动脉旁路移植术患者中，在下行胸主动脉和胸腹主动脉瘤修复时夹住左锁骨下动脉近端可引发重大心脏并发症。许多中心使用低温循环停止来避免在这些情况下需要主动脉夹闭。在此，我们描述了一种成功应用于该问题的替代方法：在动脉瘤修复前进行左颈动脉-锁骨下旁路术。该技术允许在左锁骨下动脉近端进行主动脉交叉夹闭，防止重大术中心脏并发症，并避免心肺旁路和低温循环停止。
