Nishimori Hideaki, Yamamoto Masaki, Fukutomi Takashi, Handa Takemi, Kondo Nobuo, Tashiro Miwa, Orihashi Kazumasa, Wariishi Seiichiro, Sasaguri Shiro
Department of Surgery II , Kochi University School of Medicine, Nankoku, Japan.
Kyobu Geka. 2015 Mar;68(3):163-7; discussion 167-70.
In aortic arch surgery, we reconstruct branches before opening the arch to avoid cerebral embolism of the debris derived from the aortic wall. We made a trifurcated graft for branch reconstruction using 10 mm and 8 mm polyester grafts. Cardiopulmonary bypass started under right axillary perfusion and venous drainage through the right atrium. While cooling, the left subclavian artery was clamped and anastomosed to the end of the trifurcated graft. Then the ascending aorta was cross-clamped and cardioplegic solution was infused. At 25 degrees centigrade of the tympanic temperature, the left carotid artery is clamped and anastomosed to the branch of the trifurcated graft with or without perfusion into the left carotid artery. Subsequently the brachiocephalic artery was reconstructed in the same manner. After antegrade cerebral perfusion was established through the trifurcated graft via right axillary perfusion, distal anastomosis of the aortic arch was done with the open distal technique. Graft-graft anastomosis was followed to reperfuse the lower half of the body. Finally proximal anastomosis was performed to complete total arch replacement. Forty-four patients underwent total arch replacement in this technique. In-hospital mortality was 4.5%. Cerebral infarction occurred in 4.5% of the patients probably due to embolization of the debris derived from the branches of the aortic arch.
在主动脉弓手术中，我们在打开主动脉弓之前重建分支，以避免源自主动脉壁的碎片导致脑栓塞。我们使用10毫米和8毫米的聚酯移植物制作了一个用于分支重建的三分叉移植物。体外循环在右腋动脉灌注和经右心房静脉引流下开始。降温时，夹闭左锁骨下动脉并将其与三分叉移植物的末端吻合。然后夹闭升主动脉并注入心脏停搏液。当鼓膜温度降至25摄氏度时，夹闭左颈动脉并将其与三分叉移植物的分支吻合，吻合时可选择是否对左颈动脉进行灌注。随后，以同样的方式重建头臂干动脉。通过右腋动脉灌注经三分叉移植物建立顺行性脑灌注后，采用开放远端技术进行主动脉弓远端吻合。接着进行移植物-移植物吻合，以使身体下半部重新灌注。最后进行近端吻合以完成全弓置换。44例患者采用该技术进行了全弓置换。住院死亡率为4.5%。4.5%的患者发生了脑梗死，可能是由于源自主动脉弓分支的碎片栓塞所致。
