胸主动脉腹主动脉瘤修复术后低温循环停止的结果。
Outcomes after thoracoabdominal aortic aneurysm repair with hypothermic circulatory arrest.
机构信息
Division of Cardiothoracic Surgery, Lynn Heart Institute, Boca Raton Community Hospital, Boca Raton, Fla, USA.
出版信息
J Thorac Cardiovasc Surg. 2011 Apr;141(4):953-60. doi: 10.1016/j.jtcvs.2010.06.010.
OBJECTIVE
Recent advances in endovascular surgery have put into question the role of open operative treatment of thoracoabdominal aortic aneurysms. In this context we evaluated our experience with thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass and hypothermic circulatory arrest.
METHODS
From January 1986 to December 2008, 218 patients (mean age, 63 ± 14 years) underwent thoracoabdominal aortic aneurysm repair with cardiopulmonary bypass and hypothermic circulatory arrest. The degree of repair was as follows: Crawford extent I, 57 (26%) patients; Crawford extent II, 91 (41%) patients; and Crawford extent III, 70 (32%) patients. Degenerative aneurysms were present in 160 (73%) patients. Eighteen (8%) patients underwent emergency operations.
RESULTS
The mean durations of cardiopulmonary bypass and hypothermic circulatory arrest were 160 ± 44 and 31 ± 12 minutes, respectively. Stroke occurred in 8 (3.7%) patients, and spinal cord ischemic injury occurred in 10 (4.6%) patients (8 with paraplegia and 2 with paraparesis). Temporary dialysis for new-onset renal failure was required in 3.6% of hospital survivors. Thirty-day and 1-year mortality rates were 7.3% and 24.5%, respectively. After emergency operations, the 30-day mortality rate was 33.3% compared with 5.0% after elective operations (P = .001). Five- and 10-year survivals were 55% and 23%, respectively. Twenty-five patients required reoperation on the graft or contiguous aorta at a mean of 5 ± 3 years after the initial procedure. Five- and 10-year rates of freedom from reoperation were 87% and 60%, respectively.
CONCLUSIONS
Cardiopulmonary bypass with hypothermic circulatory arrest can be safely used for thoracoabdominal aortic aneurysm repair, providing excellent protection against end-organ injury. Early mortality and morbidity rates do not exceed those reported for endovascular repair, with particularly favorable outcomes among patients undergoing elective operations.
目的
血管内治疗的最新进展使得开放手术治疗胸腹主动脉瘤的地位受到质疑。在此背景下，我们评估了体外循环结合低温循环阻断技术在胸腹主动脉瘤修复中的应用经验。
方法
1986 年 1 月至 2008 年 12 月，我们对 218 例行体外循环结合低温循环阻断技术胸腹主动脉瘤修复的患者进行了回顾性分析。手术范围：CrawfordⅠ型 57 例（26%），Ⅱ型 91 例（41%），Ⅲ型 70 例（32%）。退行性病变 160 例（73%），急症手术 18 例（8%）。
结果
体外循环和低温循环阻断的平均时间分别为 160±44min 和 31±12min。围手术期脑卒中 3.7%（8 例），脊髓缺血性损伤 4.6%（10 例，其中截瘫 8 例，下肢轻瘫 2 例）。需要临时透析的急性肾衰 3.6%。住院期间 30 天和 1 年死亡率分别为 7.3%和 24.5%。急症手术 30 天死亡率 33.3%，择期手术 5.0%（P=0.001）。术后 5 年和 10 年生存率分别为 55%和 23%。25 例患者在初次手术后平均 5±3 年因移植物或毗邻主动脉需要再次手术。术后 5 年和 10 年无再次手术生存率分别为 87%和 60%。
结论
体外循环结合低温循环阻断技术可安全用于胸腹主动脉瘤修复，能有效保护重要脏器。早期死亡率和并发症发生率与血管内修复相仿，择期手术的效果尤其好。
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