Hamamatsu University School of Medicine, Hamamatsu, Japan; ; Cardio-Vascular Center Hokkaido Ohno Hospital, Sapporo, Japan.
Ann Cardiothorac Surg. 2013 May;2(3):353-7. doi: 10.3978/j.issn.2225-319X.2013.05.05.
It is essential to select the optimum method of cerebral protection and operative technique for arch repair to improve the surgical outcome of arch aneurysm or dissection. Selective antegrade cerebral perfusion (SACP) is our current method of choice if required cerebral protection time exceeds 30 minutes. Moderate hypothermic two-arch vessel perfusion (innominate artery or right axillary artery and left common carotid artery) is safe and effective for brain protection in a majority of patients. The separated graft technique using 4-branched graft is now our preferred surgical procedure used for arch aneurysm or dissection because this technique presents several advantages over the en-bloc or island technique. SACP allows us to perform meticulous arch repair and facilitates the time-consuming total arch replacement for complex aortic arch pathology and results in an acceptable mortality (less than 4%) and morbidity (stroke 3%).
选择最佳的脑保护方法和手术技术对于弓部动脉瘤或夹层的修复至关重要，以改善手术结果。如果需要的脑保护时间超过 30 分钟，我们目前选择选择性顺行脑灌注（SACP）。对于大多数患者来说，中度低温双弓血管灌注（无名动脉或右腋动脉和左颈总动脉）是安全有效的脑保护方法。使用 4 分支移植物的游离移植物技术现在是我们治疗弓部动脉瘤或夹层的首选手术方法，因为与整块或岛状技术相比，该技术具有多项优势。SACP 使我们能够进行精细的弓部修复，并为复杂主动脉弓病变的耗时的全弓置换提供便利，其结果是可接受的死亡率（低于 4%）和发病率（脑卒中 3%）。
