Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan.
Eur J Cardiothorac Surg. 2013 Apr;43(4):e94-8. doi: 10.1093/ejcts/ezs690. Epub 2013 Jan 11.
The antegrade selective cerebral perfusion (SCP) technique, which extends the safe time limit for arch surgery, has now gained acceptance. However, neither the optimal hypothermic temperature nor the optimal SCP flow rate has been clearly determined.
From January 2008 to February 2012, a total of 105 patients underwent total arch replacement under a single surgeon (A.T.) at Shiga Medical University Hospital. The patients were 85 males and 20 females with a mean age of 73 years (range 41-88). The cause of the aneurysm was atherosclerosis in 90 patients and dissection in 15. Eighty-one patients with chronic lesion underwent elective surgery and 24 underwent emergent surgery. Univariate analysis of postoperative neurological dysfunction and early mortality was performed.
The mean operation time, cardiopulmonary bypass (CPB) time, coronary ischaemic time, lower body circulatory arrest (CA) time and SCP time were 277 ± 83 min, 164 ± 40 min, 92 ± 33 min, 58 ± 22 min and 95 ± 28 min, respectively. Thirty-day mortality occurred in 1 ruptured emergent case (1%). Hospital mortality (>30 days) occurred in 3 cases (3%), 2 due to multisystem organ failure following emergent rupture and the other to cerebrovascular accident in an elective surgery case. Permanent neurological dysfunction (PND) occurred in 3 patients (3%) and temporary neurological dysfunction (TND) also in 3 patients (3%).
SCP under mild hypothermia can be safely applied to aortic arch surgery and is associated with a low rate of hospital mortality and morbidity. However, prolonged SCP time is associated with incidences of postoperative neurological deficit.
顺行选择性脑灌注（SCP）技术延长了弓部手术的安全时限，现已被广泛接受。然而，低温的最佳温度和 SCP 的最佳流量仍未明确。
2008 年 1 月至 2012 年 2 月，共有 105 例患者由同一位外科医生（A.T.）在滋贺医科大学医院接受全主动脉弓置换术。患者 85 例为男性，20 例为女性，平均年龄为 73 岁（范围 41-88 岁）。动脉瘤的病因在 90 例患者中为动脉粥样硬化，在 15 例患者中为夹层。81 例慢性病变患者行择期手术，24 例患者行急诊手术。对术后神经功能障碍和早期死亡率进行单因素分析。
手术时间、体外循环（CPB）时间、冠状动脉缺血时间、下半身循环阻断（CA）时间和 SCP 时间分别为 277±83 分钟、164±40 分钟、92±33 分钟、58±22 分钟和 95±28 分钟。30 天死亡率为 1 例破裂性急诊病例（1%）。住院期间死亡（>30 天）发生在 3 例（3%）患者中，2 例为急诊破裂后多系统器官衰竭，另 1 例为择期手术患者发生脑血管意外。永久性神经功能障碍（PND）发生在 3 例（3%）患者中，暂时性神经功能障碍（TND）也发生在 3 例（3%）患者中。
轻度低温下的 SCP 可安全应用于主动脉弓手术，且与较低的住院死亡率和发病率相关。然而，SCP 时间延长与术后神经功能缺损的发生率相关。
