Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Eur J Cardiothorac Surg. 2012 Jan;41(1):185-91. doi: 10.1016/j.ejcts.2011.03.060.
Antegrade cerebral perfusion makes deep hypothermia non-essential for neuroprotection; therefore, there is a growing tendency to increase the body temperature during circulatory arrest with selective brain perfusion. However, very little is known about the clinical efficacy of mild-to-moderate hypothermia for ischemic organ protection during circulatory arrest. The aim of this study was to evaluate the safety and efficiency of mild-to-moderate hypothermia for lower-body protection during aortic arch surgery with circulatory arrest and antegrade cerebral perfusion.
Between January 2005 and December 2009, a total of 347 patients underwent non-emergent arch surgery. In all patients, the systematic cooling was adapted to the expected time of circulatory arrest, and cerebral perfusion was performed at a constant blood temperature of 28 °C. There were 40 cardiac or aortic re-operations, 312 patients had concomitant aortic valve or root surgery, and 10 patients had replacement of the descending aorta. All examined data were collected prospectively.
The duration of circulatory arrest and the deepest rectal temperature were 18±11 min (range, 6-70 min) and 31.5±1.6 °C (range, 26.0-35.0 °C) for all 347 patients, and 34±12 min (range, 17-70 min) and 29.9±1.7 °C (range, 26.0-34.6 °C) for 77 patients having total/subtotal arch replacement. The maximum serum lactate level on the first postoperative day was, on average, 2.3±1.2 mmol l(-1). In the statistical analysis, no association between the duration of temperature-adapted circulatory arrest and lactate, creatinine, or lactate dehydrogenase levels after surgery could be demonstrated. The 30-day mortality was 0.9%. Permanent neurological deficit or temporary dysfunction occurred in three (0.9%) and eight (2.3%) patients, respectively. No paraplegia and no hepatic failure were reported; however, mesenteric ischemia occurred in one patient with severe stenosis of the celiac and upper mesenteric arteries. Temporary dialysis was necessary primarily after surgery in five patients. All of them underwent hemiarch replacement only, and four patients had an increased creatinine level before surgery.
Systemic mild-to-moderate hypothermia that is adapted to the duration of circulatory arrest is a simple, safe, and effective method of organ protection and can be recommended in routine aortic arch surgery with circulatory arrest and cerebral perfusion.
顺行性脑灌注使深低温在神经保护方面变得非必要；因此，在选择性脑灌注下，在心脏停搏期间升高体温的趋势越来越大。然而，对于心脏停搏期间缺血器官保护，人们对中轻度低温的临床疗效知之甚少。本研究的目的是评估全身中轻度低温在顺行性脑灌注下主动脉弓手术期间下肢保护的安全性和有效性。
2005 年 1 月至 2009 年 12 月，共有 347 例患者接受了非紧急主动脉弓手术。在所有患者中，系统冷却适应预计的心脏停搏时间，并且在恒定的血液温度 28°C 下进行脑灌注。有 40 例心脏或主动脉再次手术，312 例患者同时进行主动脉瓣或根部手术，10 例患者进行降主动脉置换。所有检查数据均前瞻性收集。
347 例患者的心脏停搏时间和直肠温度最低值分别为 18±11 分钟（范围 6-70 分钟）和 31.5±1.6°C（范围 26.0-35.0°C），77 例接受全/次全主动脉弓置换术的患者分别为 34±12 分钟（范围 17-70 分钟）和 29.9±1.7°C（范围 26.0-34.6°C）。术后第一天的最大血清乳酸水平平均为 2.3±1.2mmol l(-1)。在统计学分析中，未发现温度适应的心脏停搏时间与术后乳酸、肌酐或乳酸脱氢酶水平之间存在相关性。30 天死亡率为 0.9%。永久性神经功能缺损或暂时性功能障碍分别发生在 3 例（0.9%）和 8 例（2.3%）患者中。无截瘫和肝功能衰竭发生；然而，1 例肠系膜上动脉严重狭窄的患者发生肠系膜缺血。术后 5 例患者主要需要临时透析。所有患者均仅接受半弓置换术，其中 4 例患者术前肌酐水平升高。
适应心脏停搏时间的全身中轻度低温是一种简单、安全、有效的器官保护方法，可推荐用于有心脏停搏和脑灌注的常规主动脉弓手术。
