de la Cruz Kim I, Coselli Joseph S, LeMaire Scott A
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
J Extra Corpor Technol. 2012 Mar;44(1):P42-7.
Open repair of aneurysms and dissections involving the aortic arch has traditionally been associated with high rates of morbidity and mortality, primarily because of the complications related to the need to interrupt normal blood flow to the cerebral circulation. Over the past several years, our approach to these operations has gradually changed largely through the introduction of various techniques aimed at reducing the risk of neurologic complications. Key technical changes have included the shift from using retrograde cerebral perfusion to using antegrade cerebral perfusion, the introduction of axillary artery perfusion, and the change from using the patch technique to using the Y-graft technique to reattach the brachiocephalic branches. By using this combination of techniques, surgeons can perform aortic arch replacement with excellent early outcomes. In this update, we summarize the evolution of our surgical techniques and perfusion strategies for performing open repair of the aortic arch.
涉及主动脉弓的动脉瘤和夹层的开放修复传统上与高发病率和死亡率相关，主要是因为与中断正常脑循环血流相关的并发症。在过去几年中，我们对这些手术的方法在很大程度上逐渐发生了变化，主要是通过引入各种旨在降低神经并发症风险的技术。关键的技术变化包括从使用逆行脑灌注转变为使用顺行脑灌注、引入腋动脉灌注，以及从使用补片技术转变为使用Y形移植物技术来重新连接头臂分支。通过使用这种技术组合，外科医生可以进行主动脉弓置换并获得出色的早期结果。在本更新中，我们总结了我们用于主动脉弓开放修复的手术技术和灌注策略的演变。
