Ma Hao, Xiao Zhenghua, Shi Jun, Liu Lulu, Qin Chaoyi, Guo Yingqiang
Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
J Cardiothorac Surg. 2018 Oct 11;13(1):106. doi: 10.1186/s13019-018-0779-5.
Aortic arch cannulation for an antegrade central perfusion during the surgery for Stanford type A aortic dissection can be performed within median sternotomy. We summarize the safety and convenient profile of the central cannulation strategy using the guidance of transesophageal echocardiography (TEE) in comparison to traditional femoral cannulation strategy.
Sixty-two patients with acute Stanford type A aortic dissection underwent aortic arch surgery in our hospital. All the patients were operated by the same surgeon. Cannulation was performed in 33 patients through the aortic arch under the guidance of TEE (Group A) and in 29 patients through the femoral artery (Group F). Under moderate hypothermic circulatory arrest, the brain is continuously perfused in an anterograde manner through the brachiocephalic and left common carotid arteries. Preoperative characeristics and surgical information were collected for each patient. Additionally, 30-day mortality rate and the incidence of the temporary neurological dysfunction were recorded as the outcomes. To compare the categorical variables, we used the chi-squared test. Continuous variables were compared using the t-test.
Preoperative characteristics were almost similar between the two groups. The mean operation time (7.33 ± 1.14 h vs. 8.93 ± 2.59 h, P = 0.002) and the mean cardiopulmonary bypass (CPB) time (260.97 ± 45.14 min vs. 298.28 ± 95.89 min, P = 0.024) were significantly shorter in Group A than those in Group F. The 30-day mortality rates were 9.09 and 27.59% in Groups A and F, respectively (P = 0.057). And the incidences of temporary neurological dysfunction were 39.39 and 65.52% in Group A and F, respectively (P = 0.040).
Aortic arch cannulation with the guidance of TEE during the aortic arch surgery is a simple, fast, safe, and less invasive technique for establishing cardiopulmonary bypass for Stanford type A aortic dissection.
在 Stanford A 型主动脉夹层手术中，经正中胸骨切开术可进行主动脉弓插管以进行顺行性中心灌注。我们总结了在经食管超声心动图（TEE）引导下的中心插管策略与传统股动脉插管策略相比的安全性和便利性。
62 例急性 Stanford A 型主动脉夹层患者在我院接受主动脉弓手术。所有患者均由同一位外科医生进行手术。33 例患者在 TEE 引导下经主动脉弓插管（A 组），29 例患者经股动脉插管（F 组）。在中度低温循环停止期间，通过头臂动脉和左颈总动脉以顺行方式持续灌注大脑。收集每位患者的术前特征和手术信息。此外，记录 30 天死亡率和临时神经功能障碍的发生率作为结果。为比较分类变量，我们使用卡方检验。连续变量使用 t 检验进行比较。
两组术前特征几乎相似。A 组的平均手术时间（7.33±1.14 小时 vs. 8.93±2.59 小时，P = 0.002）和平均体外循环（CPB）时间（260.97±45.14 分钟 vs. 298.28±95.89 分钟，P = 0.024）明显短于 F 组。A 组和 F 组的 30 天死亡率分别为 9.09%和 27.59%（P = 0.057）。A 组和 F 组临时神经功能障碍发生率分别为 39.39%和 65.52%（P = 0.040）。
在主动脉弓手术中，在 TEE 引导下进行主动脉弓插管是一种简单、快速、安全且侵入性较小的技术，用于为 Stanford A 型主动脉夹层建立体外循环。
