Inoue Yosuke, Minatoya Kenji, Seike Yoshimasa, Ohmura Atsushi, Uehara Kyokun, Sasaki Hiroaki, Matsuda Hitoshi, Kobayashi Junjiro
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan.
Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Gen Thorac Cardiovasc Surg. 2018 Jun;66(6):327-333. doi: 10.1007/s11748-018-0913-2. Epub 2018 Mar 29.
Partial sternotomy with limited skin incision has been utilized for cardiac surgery. We, therefore, started to apply the partial sternotomy for total arch replacement since 2013 in selected cases. The aim of this study reported the results of our early experiences.
Between July 2013 and December 2015, we retrospectively reviewed 15 cases (median age 72, range 67-84, 15 male) who underwent total arch replacement thorough partial sternotomy. All procedures were performed under hypothermic circulatory arrest with selective cerebral perfusion.
Median skin incision was 9 cm (range 7-15 cm, 5.3% of height) and partial sternotomy consisted of 14 upper and 1 lower partial sternotomy (L shape 8 and T shape 7 cases). Median operation time, cardiopulmonary bypass time, ischemic heart time, selective cerebral perfusion time and hypothermic circulatory arrest time were 485 [360-770], 223 [1174-270], 146 [100-163], 154 [116-189], and 69 [45-90] minutes, respectively. Median duration of mechanical ventilator dependent time was 12 h [5-38]. Median length of ICU stay and hospital stay were 3 [1-7], and 18 [13-76] days, respectively. Thirty days and in-hospital mortality were 0% without any neurological complications. There are two aorta-related reoperation due to graft inducing hemolytic anemia and no aorta-related death during follow-up (median 954, range 702-1462 days).
The early results of total arch replacement through partial sternotomy were satisfactory. The partial sternotomy could be a good option for total arch replacement in selected patients.
有限皮肤切口的部分胸骨切开术已用于心脏手术。因此，自2013年起，我们开始在部分病例中应用部分胸骨切开术进行全主动脉弓置换。本研究旨在报告我们早期经验的结果。
2013年7月至2015年12月，我们回顾性分析了15例行部分胸骨切开术全主动脉弓置换术的患者（中位年龄72岁，范围67 - 84岁，均为男性）。所有手术均在低温循环停止及选择性脑灌注下进行。
中位皮肤切口长度为9 cm（范围7 - 15 cm，占身高的5.3%），部分胸骨切开术包括14例上半部分胸骨切开和1例下半部分胸骨切开（L形8例，T形7例）。中位手术时间、体外循环时间、缺血心脏时间、选择性脑灌注时间和低温循环停止时间分别为485 [360 - 770]、223 [117 - 270]、146 [100 - 163]、154 [116 - 189]和69 [45 - 90]分钟。机械通气依赖时间的中位数为12小时[5 - 38]。ICU住院时间和住院时间的中位数分别为3 [1 - 7]天和18 [13 - 76]天。30天和住院死亡率均为0%，无任何神经系统并发症。随访期间（中位954天，范围702 - 1462天），因移植物导致溶血性贫血行2次与主动脉相关的再次手术，无主动脉相关死亡。
部分胸骨切开术全主动脉弓置换术的早期结果令人满意。部分胸骨切开术对于部分患者可能是全主动脉弓置换的一个良好选择。
