Department of Congenital Heart Surgery, Marie Lannelongue Hospital, University Paris-Sud, Le Plessis-Robinson, France.
Ann Thorac Surg. 2011 Sep;92(3):942-8; discussion 948. doi: 10.1016/j.athoracsur.2011.03.006. Epub 2011 Jun 24.
Deep hypothermia with circulatory arrest (CA) is routinely used for aortic arch repair. Antegrade selective cerebral perfusion (ASCP) has been proposed to avoid neurologic complications. The optimal temperature during aortic arch repair with ASCP is not well established. We therefore compared early outcomes of patients undergoing aortic arch repair associated with intracardiac repair with ASCP either with hypothermia (<28°C, group I; n=70) or normothermia (>34°C, group II; n=40).
From 2002 to 2008, 110 consecutive patients with interrupted aortic arch (n=40) or coarctation of the aorta (n=70) and cardiac anomalies underwent intracardiac and aortic arch repair without CA. Median age at repair was 12 days. Full cardiopulmonary bypass (CPB), high hematocrit, and high rates of flow were used. ASCP flow was adjusted to maintain arterial pressure at greater than or equal to 50 mm Hg. ASCP was achieved either through a Gore-Tex (W. L. Gore & Associates, Inc., Elkton, MD) graft to the innominate artery (n=36) or by direct cannulation (n=74). An electroencephalogram (EEG) was continuously monitored and 30 patients were monitored by near-infrared spectroscopy (NIRS).
Preoperative data were similar in both groups. Group II demonstrated higher ASCP flows (p<0.001). Time to extubation, stay in the intensive care unit (ICU), and postoperative urine output and lactate levels were similar between groups. Mortality was 8.5% in group I versus 10% in group II. During the postoperative course, there were no clinical or electrical neurologic events in either group.
Antegrade selective cerebral perfusion can safely avoid CA. No worse, early, or long-term effects of ASCP with normothermia were found.
深低温停循环（CA）通常用于主动脉弓修复。顺行选择性脑灌注（ASCP）已被提议用于避免神经并发症。在使用 ASCP 进行主动脉弓修复时，最佳温度尚未确定。因此，我们比较了在 ASCP 下进行心脏内修复的主动脉弓修复患者的早期结果，其中使用低温（<28°C，I 组；n=70）或正常体温（>34°C，II 组；n=40）。
2002 年至 2008 年，连续 110 例患有中断主动脉弓（n=40）或主动脉缩窄（n=70）和心脏畸形的患者在无 CA 的情况下进行心脏内和主动脉弓修复。修复时的中位年龄为 12 天。使用全心肺旁路（CPB）、高血细胞比容和高流量。ASCP 流量调整为维持动脉压大于或等于 50mmHg。通过 Gore-Tex（W. L. Gore & Associates，Inc.，Elkton，MD）移植物到无名动脉（n=36）或直接插管（n=74）实现 ASCP。连续监测脑电图（EEG），30 例患者监测近红外光谱（NIRS）。
两组术前数据相似。II 组显示出更高的 ASCP 流量（p<0.001）。拔管时间、重症监护病房（ICU）停留时间、术后尿量和乳酸水平在两组之间相似。I 组死亡率为 8.5%，II 组为 10%。在术后过程中，两组均无临床或电神经事件。
顺行选择性脑灌注可安全避免 CA。未发现正常体温下使用 ASCP 的更差、早期或长期影响。
