Kim Tae Yun, Kim Kyung Hwa
Department of Thoracic and Cardiovascular Surgery, Chonbuk, National University Medical School, Chonbuk National University Hospital, 20 Geonji-Ro, Geumam-dong, Deokjin-gu, Jeonju, 54907, South Korea.
Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, 20 Geonji-Ro, Geumam-dong, Deokjin-gu, Jeonju, 54907, South Korea.
J Cardiothorac Surg. 2019 Jan 10;14(1):9. doi: 10.1186/s13019-018-0826-2.
Open distal graft to proximal aortic arch anastomosis is central to a hemiarch replacement. Even if the ischemic tolerance time of several organs during circulatory arrest (CA) at normothermia is much longer than that of the brain, very little is known about the safety and clinical efficacy of moderate hypothermia for organ protection during the average duration of CA needed for aortic arch replacement. Hemiarch replacement using the standard techniques of deep hypothermia and antegrade perfusion has often ignored the effects of prolonged distal body CA. Maintenance of distal organ, especially the liver and kidney, perfusion reduces the risk of postoperative renal dysfunction and coagulopathy.
A 72-year-old female patient was referred to our institute due to chest discomfort. Radiologic investigations revealed a giant aneurysm of the ascending aorta extending but confined to the proximal aortic arch. We performed an alternative technique for hemiarch replacement using a dual inflow source.
Although this technique cannot apply to all aneurysmal aortic diseases, our basic technique involving the use of dual inflow may be well suited for standard hemiarch replacement that is confined to the proximal aortic arch, given the shortening of the bypass and ischemic times.
开放的远端移植物与近端主动脉弓吻合术是半弓置换术的核心。即使在常温下循环骤停（CA）期间几个器官的缺血耐受时间远长于脑，但对于在主动脉弓置换所需的平均CA持续时间内进行中度低温以保护器官的安全性和临床疗效却知之甚少。使用深低温和顺行灌注的标准技术进行半弓置换术常常忽略了远端身体CA延长的影响。维持远端器官（尤其是肝脏和肾脏）的灌注可降低术后肾功能不全和凝血病的风险。
一名72岁女性患者因胸部不适被转诊至我院。影像学检查发现升主动脉巨大动脉瘤，延伸至但局限于近端主动脉弓。我们采用了一种使用双流入源的替代技术进行半弓置换术。
尽管该技术不能适用于所有主动脉瘤疾病，但鉴于旁路和缺血时间的缩短，我们涉及使用双流入的基本技术可能非常适合局限于近端主动脉弓的标准半弓置换术。
