Ogino Hitoshi
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
Nihon Geka Gakkai Zasshi. 2011 Jan;112(1):5-10.
The surgical treatment of aortic arch aneurysm including newly developed procedures and their outcomes is reviewed. Major advances in aortic arch repair have been made by meticulous brain protection with antegrade-selective and retrograde cerebral perfusion in addition to hypothermia circulatory arrest and refinement of surgical techniques. Total arch replacement using a multibranched prosthetic graft with antegrade-selective cerebral perfusion (SCP) under hypothermia through a median sternotomy has been standardized, resulting in lower mortality and cerebral mortality rates. In particular, the impact of the use of the axillary artery for cardiopulmonary bypass and of the stepwise or elephant trunk technique for distal anastomosis has recently been assessed. In addition, arch repair under moderate hypothermia in conjunction with SCP has been attempted without any serious problems. The surgical strategy for extended aortic aneurysms is also of concern. A two-stage approach with an elephant trunk procedure is employed predominantly for high-risk patients, while one-stage repair is aggressively applied for relatively young, low-risk patients. In contrast, there has been great progress in stent graft therapy for aortic arch lesions. Arch stent graft repairs including hybrid procedures have been attempted in elderly, high-risk patients. Consequently, these comorbid procedures can be used satisfactorily.
本文综述了主动脉弓动脉瘤的外科治疗，包括新开发的手术方法及其疗效。除了低温循环停搏和手术技术的改进外，通过顺行选择性和逆行脑灌注进行细致的脑保护，在主动脉弓修复方面取得了重大进展。采用多分支人工血管移植物，在低温下通过正中胸骨切开术进行顺行选择性脑灌注（SCP）的全弓置换已标准化，从而降低了死亡率和脑死亡率。特别是，最近评估了使用腋动脉进行体外循环以及采用逐步或象鼻技术进行远端吻合的影响。此外，在中度低温联合SCP的情况下进行弓部修复也已尝试，且未出现任何严重问题。对于累及范围更广的主动脉瘤，其手术策略也备受关注。对于高危患者，主要采用两阶段象鼻手术方法，而对于相对年轻、低风险的患者，则积极采用一期修复。相比之下，主动脉弓病变的支架移植物治疗取得了很大进展。包括杂交手术在内的弓部支架移植物修复已在老年高危患者中尝试。因此，这些合并手术可以得到满意的应用。
