Hammel James M
Cardiothoracic Surgery, Children's Hospital and Medical Center, Omaha, Nebraska.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2019;22:14-20. doi: 10.1053/j.pcsu.2019.02.010.
The established techniques of deep hypothermia with circulatory arrest and regional cerebral perfusion expose infants and children to additional physiologic stress and deleterious effects which may adversely affect the outcome of operations involving reconstruction of the aortic arch. Alternative techniques to supplement perfusion support are an area of innovation today. The most effective adjunct for somatic perfusion during arch reconstruction is direct cannulation of the innominate artery and the descending aorta, with full flow at mild hypothermia distributed throughout the entire body just as it is during routine, single cannulation surgery with an intact aorta. Detailed facilitating techniques for descending aortic cannulation are discussed.
传统的深低温停循环和选择性脑灌注技术会使婴幼儿承受额外的生理应激和有害影响，这可能对涉及主动脉弓重建的手术结果产生不利影响。补充灌注支持的替代技术是当今的一个创新领域。在主动脉弓重建期间进行体循环灌注最有效的辅助方法是直接对无名动脉和降主动脉进行插管，在轻度低温下以全流量将血液分布到全身，就如同在主动脉完整的常规单插管手术中一样。文中讨论了降主动脉插管的详细辅助技术。
