Maier Sven, Kari Fabian, Rylski Bartosz, Siepe Matthias, Benk Christoph, Beyersdorf Friedhelm
Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany.
J Extra Corpor Technol. 2016 Sep;48(3):122-128.
Open aortic arch replacement is a complex and challenging procedure, especially in post dissection aneurysms and in redo procedures after previous surgery of the ascending aorta or aortic root. We report our experience with the simultaneous selective perfusion of heart, brain, and remaining body to ensure optimal perfusion and to minimize perfusion-related risks during these procedures. We used a specially configured heart-lung machine with a centrifugal pump as arterial pump and an additional roller pump for the selective cerebral perfusion. Initial arterial cannulation is achieved via femoral artery or right axillary artery. After lower body circulatory arrest and selective antegrade cerebral perfusion for the distal arch anastomosis, we started selective lower body perfusion simultaneously to the selective antegrade cerebral perfusion and heart perfusion. Eighteen patients were successfully treated with this perfusion strategy from October 2012 to November 2015. No complications related to the heart-lung machine and the cannulation occurred during the procedures. Mean cardiopulmonary bypass time was 239 ± 33 minutes, the simultaneous selective perfusion of brain, heart, and remaining body lasted 55 ± 23 minutes. One patient suffered temporary neurological deficit that resolved completely during intensive care unit stay. No patient experienced a permanent neurological deficit or end-organ dysfunction. These high-risk procedures require a concept with a special setup of the heart-lung machine. Our perfusion strategy for aortic arch replacement ensures a selective perfusion of heart, brain, and lower body during this complex procedure and we observed excellent outcomes in this small series. This perfusion strategy is also applicable for redo procedures.
开放主动脉弓置换术是一项复杂且具有挑战性的手术，尤其是在夹层动脉瘤以及升主动脉或主动脉根部既往手术后的再次手术中。我们报告了我们在心脏、脑和身体其余部分同时进行选择性灌注的经验，以确保在这些手术中实现最佳灌注并将灌注相关风险降至最低。我们使用了一种特殊配置的心肺机，其中离心泵作为动脉泵，另外还有一个滚压泵用于选择性脑灌注。初始动脉插管通过股动脉或右腋动脉进行。在进行下半身循环停搏并为远端弓部吻合进行选择性顺行性脑灌注后，我们开始在进行选择性顺行性脑灌注和心脏灌注的同时进行选择性下半身灌注。从2012年10月至2015年11月，18例患者采用这种灌注策略成功接受治疗。手术过程中未发生与心肺机和插管相关的并发症。平均体外循环时间为239±33分钟，脑、心脏和身体其余部分的同时选择性灌注持续55±23分钟。1例患者出现短暂性神经功能缺损，在重症监护病房住院期间完全恢复。没有患者出现永久性神经功能缺损或终末器官功能障碍。这些高风险手术需要一种具有特殊心肺机设置的理念。我们的主动脉弓置换术灌注策略可在这一复杂手术过程中确保对心脏、脑和下半身进行选择性灌注，并在这一小系列病例中观察到了出色的结果。这种灌注策略也适用于再次手术。
