Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Eur J Cardiothorac Surg. 2013 Jul;44(1):48-53. doi: 10.1093/ejcts/ezs695. Epub 2013 Jan 16.
New surgical and perfusion techniques allow the avoidance of deep hypothermia during open aortic arch surgery, which is generally necessary in patients with an unclampable porcelain aorta. The aim of the study was to evaluate operative and long-term results in patients with a porcelain aorta who underwent conventional cardiac surgery using current surgical and perfusion techniques.
Between November 2003 and February 2012, 30 consecutive patients (mean age 68 ± 11 years, 10 patients had previous cardiac surgery with use of glue in 5 of them) with porcelain aorta diagnosed by computed tomography and defined as a severe circular calcification of the proximal thoracic aorta were referred for cardiac surgery. All patients underwent conventional surgery with arterial cannulation of the innominate (8) or a carotid artery (22) for arterial return. During mild hypothermic circulatory arrest, unilateral cerebral perfusion through the arterial line was performed for cerebral protection. The valve surgery consisted of aortic, mitral or double valve repair in 23, 3 and 4 cases, respectively. Aortic surgery (17 complete root replacements with valve composite grafts and 22 arch replacements) and coronary revascularization due to coronary heart disease (15) were the most frequent concomitant procedures.
Thirty-day mortality was 3.3% (1 patient died of bowel ischaemia caused by severe stenosis of the celiac and upper mesenteric arteries) and the rate of permanent neurological deficit was 3.3% as well. Two further patients died during the follow-up at age 91 and 82 years, respectively; however, no death was cardiac or valve related. The actuarial survival at 5 years was 87.3 ± 7.2%. There were no cardiac reoperations, new interventions or aortic- or valve-related events noted during the median follow-up of 45 months (range 0.1-106.0).
Conventional cardiac and aortic surgery offers definitive repair and can be performed safely using current perfusion and operative techniques. Although more invasive, this surgical technique provides mortality and morbidity rates that do not exceed those reported for transcatheter valve implantation. The curative replacement of the pathological proximal aorta, which is one of the most main sources of cerebral embolism, leads to excellent neurological outcome during mid- to long-term follow-up.
新的手术和灌注技术可避免在开放式主动脉弓手术中出现深度低温，而对于无法夹闭的陶瓷主动脉患者，一般需要进行这种手术。本研究的目的是评估采用当前手术和灌注技术对患有陶瓷主动脉的患者进行常规心脏手术的手术和长期结果。
2003 年 11 月至 2012 年 2 月，连续 30 例（平均年龄 68±11 岁，其中 10 例患者因之前的心脏手术中使用了胶水）被诊断为患有陶瓷主动脉的患者（通过计算机断层扫描检查，定义为近端胸主动脉严重环状钙化）接受心脏手术。所有患者均采用常规手术，无名动脉（8 例）或颈动脉（22 例）插管进行动脉回流。在轻度低温体外循环期间，通过动脉线进行单侧脑灌注以进行脑保护。瓣膜手术包括主动脉瓣、二尖瓣或双瓣修复，分别为 23、3 和 4 例。主动脉手术（17 例完整根部置换术伴复合瓣膜移植物和 22 例弓部置换术）和因冠心病而行的冠状动脉血运重建术（15 例）是最常见的合并手术。
30 天死亡率为 3.3%（1 例患者因腹腔干和肠系膜上动脉严重狭窄导致肠缺血而死亡），永久性神经功能缺损的发生率也为 3.3%。另外两名患者在随访中分别于 91 岁和 82 岁时死亡，但均与心脏或瓣膜无关。5 年的累积生存率为 87.3±7.2%。在中位数为 45 个月（0.1-106.0）的随访期间，没有心脏再次手术、新的介入治疗或主动脉瓣或瓣膜相关事件。
传统的心脏和主动脉手术可进行确定性修复，并且可以使用当前的灌注和手术技术安全地进行。尽管侵入性更大，但这种手术技术的死亡率和发病率并不超过经导管瓣膜植入术报道的死亡率和发病率。对病变的近端主动脉进行有创性置换，这是脑栓塞的主要来源之一，可在中期至长期随访中获得极好的神经学结果。
