Li Quan, Qu Hong, Liu Tianqi, Li Min, Chen Shanliang, Li Peijie, Xu Li, Wang Hengbao
Division of Cardiac Surgery, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Affiliated Hospital of Shandong University, Jinan, Shandong, China, 16766 Jingshi Road, Jinan, 250014, Shandong, China.
J Cardiothorac Surg. 2020 Feb 22;15(1):38. doi: 10.1186/s13019-020-1082-9.
Patients with DeBakey type II aortic dissection or ascending aortic aneurysms involving the right innominate artery require hemiarch replacement and placement of a right innominate artery graft. Traditional aortic hemiarch replacement surgery must be performed under right axillary artery cannulation perfusion and moderate or deep hypothermia circulatory arrest. However, the axillary artery perfusion is always associated with left subclavian artery "steal blood", and it cannot guarantee blood supply to the left cerebral hemisphere in patients with an incomplete circle of Willis, and hypothermia and hypoperfusion cause damage to the brain and spinal cord; therefore, postoperative complications of the nervous system are common. Herein, we present a hemiarch replacement procedure with the use of the single branch-first combined with the mid-arch clamping technique. This procedure can not only reduce the axillary artery incision but also eliminate the need for mid-deep hypothermia and circulatory arrest.
A 41-year-old male patient underwent surgery with this technique. Computed tomography angiography performed upon admission showed calcified plaques scattered throughout the aorta and showed DeBakey type II aortic dissection involving the right innominate artery, accompanied by cardiac tamponade. The patient underwent aortic root repair, ascending aorta replacement, and hemiarch replacement as well as the placement of a right innominate artery graft. Aortic root anastomosis was performed with the embedded anastomosis technique. There were no postoperative complications. The patient was discharged 11 days after the operation. During more than 3 months of follow-up, there were no cases of aortic valve regurgitation or anastomotic fistula.
The single branch-first combined with the mid-arch clamping technique for the right innominate artery can reduce the axillary artery incision and avoid damage to the body under mid-deep hypothermia and circulatory arrest. The embedded anastomosis technique is easy to perform, results in a limited amount of bleeding and requires almost no extra needling. We believe that these techniques can serve as good alternative strategies for patients with DeBakey type II aortic dissection or ascending aortic aneurysms involving the right innominate artery.
患有DeBakey II型主动脉夹层或累及右无名动脉的升主动脉瘤的患者需要进行半弓置换并植入右无名动脉移植物。传统的主动脉半弓置换手术必须在右腋动脉插管灌注及中度或深度低温循环停搏下进行。然而，腋动脉灌注总是伴有左锁骨下动脉“盗血”现象，并且对于Willis环不完整的患者无法保证左脑半球的血液供应，而且低温和低灌注会对脑和脊髓造成损伤；因此，神经系统术后并发症很常见。在此，我们介绍一种使用单分支优先联合弓中部阻断技术的半弓置换手术方法。该方法不仅可以减少腋动脉切口，还能避免中度至深度低温和循环停搏。
一名41岁男性患者接受了该技术的手术。入院时进行的计算机断层扫描血管造影显示主动脉全程散在钙化斑块，并显示DeBakey II型主动脉夹层累及右无名动脉，伴有心脏压塞。患者接受了主动脉根部修复、升主动脉置换、半弓置换以及右无名动脉移植物植入。采用嵌入式吻合技术进行主动脉根部吻合。术后无并发症。患者术后11天出院。在超过3个月的随访期间，未出现主动脉瓣反流或吻合口瘘的情况。
针对右无名动脉采用单分支优先联合弓中部阻断技术可减少腋动脉切口，并避免在中度至深度低温和循环停搏下对身体造成损伤。嵌入式吻合技术操作简便，出血量有限，几乎无需额外缝针。我们认为这些技术可为患有DeBakey II型主动脉夹层或累及右无名动脉的升主动脉瘤的患者提供良好的替代策略。
