Ishihara H, Hamanaka Y, Kawaue Y, Sueda T, Kanehiro K, Matsuura Y
First Department of Surgery, Hiroshima.
Nihon Geka Hokan. 1990 Jan 1;59(1):3-9.
Between January 1987, and December 1988, 14 cases of descending thoracic or thoraco-abdominal aortic aneurysm underwent operation using a prosthetic graft replacement. In order to avoid hypoperfusion to distal organs and proximal hypertension during aortic cross-clamping, two different adjuncts were used and the effectiveness of those methods were compared according to the results of surgery. Seven patients were treated with a temporary shunt of heparin-bonded tube from the left axillary artery to left femoral artery, or else Dacron vascular prosthesis from right axillary artery to right femoral artery (Group I). In Group II (seven patients), left heart bypass was performed, using a centrifugal pump from the left atrium to the left femoral artery with minimal heparinization. In Group I, there were two hospital deaths, due to respiratory and hepatic failure respectively, and paraplegia has occurred in one case. In Group II, there was no death during a post-operative observation period of 5-15 months, and there was no case of paraplegia. We think that temporary left heart bypass with a centrifugal pump seems to be the most useful method today for graft replacement of the descending thoracic or thoraco-abdominal aorta.
1987年1月至1988年12月期间，14例降胸段或胸腹主动脉瘤患者接受了人工血管置换手术。为避免主动脉阻断期间远端器官灌注不足和近端高血压，采用了两种不同的辅助方法，并根据手术结果比较了这些方法的有效性。7例患者采用肝素结合管从左腋动脉至左股动脉的临时分流，或采用涤纶血管假体从右腋动脉至右股动脉（第一组）。第二组（7例患者）采用左心转流，使用离心泵从左心房至左股动脉，并采用最小剂量肝素化。第一组有2例医院死亡，分别死于呼吸和肝功能衰竭，1例发生截瘫。第二组在术后5至15个月的观察期内无死亡，也无截瘫病例。我们认为，目前采用离心泵进行临时左心转流似乎是降胸段或胸腹主动脉人工血管置换最有效的方法。
