Kaplan Mehmet, Temur Bahar, Can Tolga, Abay Gunseli, Olsun Adlan, Aydogan Hakki
Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Anesthesiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Heart Surg Forum. 2015 Aug 30;18(4):E124-8. doi: 10.1532/hsf.1284.
This study aimed to report the outcomes of patients who underwent proximal thoracic aortic aneurysm surgery with open distal anastomosis technique but without cerebral perfusion, instead under deep hypothermic circulatory arrest.
Thirty patients (21 male, 9 female) who underwent ascending aortic aneurysm repair with open distal anastomosis technique were included. The average age was 60.2±11.7 years. Operations were performed under deep hypothermic circulatory arrest and the cannulation for cardiopulmonary bypass was first done over the aneurysmatic segment and then moved over the graft. Intraoperative and early postoperative mortality and morbidity outcomes were reported.
Average duration of cardiopulmonary bypass and cross-clamps were 210.8±43 and 154.9±35.4 minutes, respectively. Average duration of total circulatory arrest was 25.2±2.4 minutes. There was one hospital death (3.3%) due to chronic obstructive pulmonary disease at postoperative day 22. No neurological dysfunction was observed during the postoperative period.
These results demonstrate that open distal anastomosis under less than 30 minutes of deep hypothermic circulatory arrest without antegrade or retrograde cerebral perfusion and cannulation of the aneurysmatic segment is a safe and reliable procedure in patients undergoing proximal thoracic aortic aneurysm surgery.
本研究旨在报告采用开放远端吻合技术但未进行脑灌注，而是在深低温停循环下进行近端胸主动脉瘤手术患者的治疗结果。
纳入30例采用开放远端吻合技术进行升主动脉瘤修复的患者（男性21例，女性9例）。平均年龄为60.2±11.7岁。手术在深低温停循环下进行，体外循环插管首先置于动脉瘤段上方，然后移至移植物上方。报告了术中和术后早期的死亡率和发病率结果。
体外循环和主动脉阻断的平均时间分别为210.8±43分钟和154.9±35.4分钟。总停循环平均时间为25.2±2.4分钟。术后第22天有1例因慢性阻塞性肺疾病死亡（3.3%）。术后期间未观察到神经功能障碍。
这些结果表明，在深低温停循环少于30分钟、未进行顺行或逆行脑灌注且动脉瘤段插管的情况下进行开放远端吻合，对于接受近端胸主动脉瘤手术的患者是一种安全可靠的手术方法。
