Gatti Giuseppe, Benussi Bernardo, Currò Placido, Forti Gabriella, Rauber Elisabetta, Minati Alessandro, Gabrielli Marco, Tognolli Umberto, Sinagra Gianfranco, Pappalardo Aniello
Cardiovascular Department, University Hospital of Trieste, Italy.
Cardiovascular Department, University Hospital of Trieste, Italy.
J Stroke Cerebrovasc Dis. 2017 Dec;26(12):3009-3019. doi: 10.1016/j.jstrokecerebrovasdis.2017.07.034. Epub 2017 Aug 24.
Retrograde cerebral perfusion (RCP) is a brain protection technique that is adopted generally for anticipated short periods of deep hypothermic circulatory arrest (DHCA). However, the real impact of this technique on cerebral protection during DHCA remains a controversial issue.
For 344 (59.5%) of 578 consecutive patients (mean age, 66.9 ± 10.9 years) who underwent cardiovascular surgery under DHCA at the present authors' institution (1999-2015), RCP was the sole technique of cerebral protection that was adopted in addition to deep hypothermia. Surgery of the thoracic aorta was performed in 95.9% of these RCP patients; in 92 cases there was an aortic arch involvement. Outcomes were reviewed retrospectively. The focus was on postoperative neurological dysfunctions.
There were 33 (9.6%) in-hospital deaths. Thirty-one (9%) patients had permanent neurological dysfunctions and 66 (19.1%) transitory neurological dysfunctions alone. Age older than 74 years (odds ratio [OR], 1.88, P = .023), surgery for acute aortic dissection (OR, 2.57; P = .0009), and DHCA time longer than 25 minutes (OR, 2.44; P = .0021) were predictors of neurological dysfunctions. The 10-year nonparametric estimate of freedom from all-cause death was 61.8% (95% confidence interval, 57.8%-65.8%). Permanent postoperative neurological dysfunctions were risk factors for cardiac or cerebrovascular death (hazard ratio, 2.6; P = .039) even after an adjusted survival analysis (P < .04).
According to the study findings, RCP, in addition to deep hypothermia, combines with a low risk of neurological dysfunctions provided that DHCA length is 25 minutes or less. Permanent postoperative neurological dysfunctions are predictors of poor late survival.
逆行脑灌注（RCP）是一种常用于预期短时间深低温停循环（DHCA）的脑保护技术。然而，该技术在DHCA期间对脑保护的实际影响仍是一个有争议的问题。
在本研究机构（1999 - 2015年）接受DHCA下心血管手术的578例连续患者（平均年龄66.9±10.9岁）中，344例（59.5%）患者将RCP作为除深低温外采用的唯一脑保护技术。这些接受RCP的患者中95.9%进行了胸主动脉手术；92例累及主动脉弓。对结果进行回顾性分析。重点关注术后神经功能障碍。
有33例（9.6%）住院死亡。31例（9%）患者有永久性神经功能障碍，66例（19.1%）仅有短暂性神经功能障碍。年龄大于74岁（比值比[OR]，1.88，P = 0.023）、急性主动脉夹层手术（OR，2.57；P = 0.0009）以及DHCA时间超过25分钟（OR，2.44；P = 0.0021）是神经功能障碍的预测因素。全因死亡的10年非参数估计生存率为61.8%（95%置信区间，57.8% - 65.8%）。即使经过校正生存分析（P < 0.04），术后永久性神经功能障碍仍是心脏或脑血管死亡的危险因素（风险比，2.6；P = 0.039）。
根据研究结果，除深低温外，只要DHCA时间为25分钟或更短，RCP导致神经功能障碍的风险较低。术后永久性神经功能障碍是晚期生存不良的预测因素。
