Long Chaozhong, Feng Yaoguang, He Dapu, Wang Yuanxing, Lyv Xiaolin, Kuang Wenan
Department of Cardiothoracic Surgery, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China.
J Card Surg. 2019 Jun;34(6):499-502. doi: 10.1111/jocs.14043. Epub 2019 Apr 8.
The technical essentials of the procedure include femoral artery cannulation, selective antegrade cerebral perfusion for brain protection, total arch replacement with a 4-branched vascular graft, implantation of the special open stented graft into the descending aorta, moderate hypothermic balloon occluding descending aorta at 25℃. This technique allows arch reconstruction to be debranched first and upper part of the body is perfused via the 4-branched vascular graft, ensuring antegrade true lumen cerebral perfusion rapidly secured, the descending aorta is arrested by balloon occluding and early rewarming and reperfusion after distal anastomosis to minimize organs ischemia.
该手术的技术要点包括股动脉插管、选择性顺行脑灌注以保护大脑、用四分支血管移植物进行全弓置换、将特殊的开放式带支架移植物植入降主动脉、在25℃下进行中度低温球囊阻断降主动脉。该技术允许先进行去分支的弓部重建，通过四分支血管移植物灌注身体上部，确保快速实现顺行真腔脑灌注，通过球囊阻断使降主动脉停止血流，并在远端吻合术后早期复温和再灌注，以尽量减少器官缺血。
