Tajima Kazuyoshi
Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan,
Gen Thorac Cardiovasc Surg. 2014 May;62(5):273-81. doi: 10.1007/s11748-014-0388-8. Epub 2014 Mar 18.
As its outcomes improve, cardiac surgery has been performed on more and more cases which were previously considered to be difficult to deal with. However, there are still a number of problems to be solved regarding surgery on patients with severe sclerotic lesions in the ascending aorta, which we collectively call "bad aorta". Concerning a preoperative assessment of the ascending aorta, our report revealed no relationship between the severity of calcification detected with a preoperative non-enhanced CT and the aortic lesion found during the surgery. Meanwhile, an intraoperative epiaortic ultrasound enables us to make high-quality evaluations of the aorta without imposing much burden on the patient. This modality may be essential for cardiac surgery. As for surgical management for bad aorta, quite a few methods have been reported to this point, but the overall operative mortality rate and cerebrovascular accident rate are relatively high, at a little <10 %, respectively. With the recent cross-clamping method under short-term total circulatory arrest (TCA), however, the results are much better; these rates total around 5 %. Further improvement is expected in the outcome of cardiac surgery on bad aorta cases by establishing a modality to evaluate sclerotic lesions in the ascending aorta with epiaortic ultrasound and by selecting a proper procedure for each case.
随着心脏手术效果的改善，越来越多以前被认为难以处理的病例接受了心脏手术。然而，对于升主动脉严重硬化病变患者的手术，仍有许多问题有待解决，我们将这类患者统称为“不良主动脉”患者。关于升主动脉的术前评估，我们的报告显示，术前非增强CT检测到的钙化严重程度与手术中发现的主动脉病变之间没有关联。同时，术中主动脉外膜超声检查能够在不给患者带来太多负担的情况下，对主动脉进行高质量评估。这种检查方式对于心脏手术可能至关重要。至于不良主动脉的手术处理，到目前为止已经报道了不少方法，但总体手术死亡率和脑血管意外发生率相对较高，分别略低于10%。然而，采用近期的短期全循环阻断（TCA）下的交叉钳夹方法，结果要好得多；这些比率总计约为5%。通过建立一种利用主动脉外膜超声评估升主动脉硬化病变的方式，并为每个病例选择合适的手术方法，有望进一步改善不良主动脉病例的心脏手术效果。
