Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan.
Heart Surg Forum. 2020 Sep 23;23(5):E673-E676. doi: 10.1532/hsf.3135.
Stroke and paraplegia are serious complications of total aortic arch replacement (TAR). Hypothermic circulatory arrest and cerebral perfusion reduce the risk of neurologic complications, but longer circulatory arrest time remains a risk factor for such complications. We utilized a frozen elephant trunk (FET) with endo-balloon occlusion under mild systemic hypothermia, which allowed us to shorten circulatory arrest time.
Between April 2007 and May 2020, 72 patients underwent elective TAR using antegrade cerebral perfusion (ACP). They were divided into 2 groups. 64 patients received conventional TAR with moderate systemic hypothermic (bladder temperature, 25-28°C) circulatory arrest (group C). We used a FET with endo-balloon occlusion and retrograde perfusion through the femoral artery for the newest 8 patients who had mild hypothermic (bladder temperature of 30°C) circulatory arrest (group B).
The mean operation time (257.5 ± 42.1 versus 327.8 ± 84.9 min, P = .023), CPB time (144.4 ± 28.1 versus 178.2 ± 26.4 min, P = .003), cardiac arrest time (75.5 ± 21.2 versus 95.7 ± 56.4 min, P < .001), SCP time (100.8 ± 25.5 versus 124 ± 23.2 min, P < .001), lower body circulation arrest time (17.2 ± 4.2 versus 62.5 ± 19.3 min, P < .001) were significantly shorter in the endo-balloon occlusion group. There were no perioperative neurological and renal complications or mortality in FET group. The new technique enabled a decrease in mechanical ventilation time (8.6 ± 1.4 versus 13.9 ± 5.7 min, P = .015) and hospital length of stay (9.7 ± 1.8 versus 18.3 ± 4.6 min, P = .005).
FET using an endo-balloon occlusion with mild hypothermia is a safe and an effective approach in TAR.
全主动脉弓置换术（TAR）可导致中风和截瘫等严重并发症。低温体外循环和脑灌注可降低神经并发症的风险，但较长的体外循环时间仍是此类并发症的一个危险因素。我们采用低温下带内囊球囊阻断的冷冻象鼻（FET），以缩短体外循环时间。
2007 年 4 月至 2020 年 5 月，72 例行顺行脑灌注（ACP）的择期 TAR 患者被分为 2 组。64 例行常规 TAR 并采用中度全身低温（膀胱温度 25-28°C）体外循环（C 组）。最近 8 例患者采用低温（膀胱温度 30°C）体外循环，采用带内囊球囊阻断和股动脉逆行灌注的 FET（B 组）。
平均手术时间（257.5±42.1 分钟比 327.8±84.9 分钟，P=0.023）、CPB 时间（144.4±28.1 分钟比 178.2±26.4 分钟，P=0.003）、心脏停搏时间（75.5±21.2 分钟比 95.7±56.4 分钟，P<0.001）、选择性顺行脑灌注时间（100.8±25.5 分钟比 124±23.2 分钟，P<0.001）、下半身体外循环时间（17.2±4.2 分钟比 62.5±19.3 分钟，P<0.001）明显缩短。球囊阻断组无围手术期神经和肾脏并发症或死亡。新技术可减少机械通气时间（8.6±1.4 分钟比 13.9±5.7 分钟，P=0.015）和住院时间（9.7±1.8 分钟比 18.3±4.6 分钟，P=0.005）。
低温下带内囊球囊阻断的 FET 是 TAR 安全有效的方法。
