Das Debasis, Dutta Nilanjan, Roy Chowdhuri Kuntal
Department of Cardiac Surgery, Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah, 711103 India.
Department of Cardiac Surgery, BM Birla Heart Research Centre, 1, National Library Avenue, Alipore, Kolkata, 700027 India.
Indian J Thorac Cardiovasc Surg. 2021 Jan;37(Suppl 1):165-173. doi: 10.1007/s12055-020-00930-3. Epub 2020 Mar 9.
The use of total circulatory arrest (TCA)/deep hypothermic circulatory arrest (DHCA) as a support modality in congenital heart surgery is a time-tested strategy. However, with technological advances, the widespread use of this technique has decreased. Adjunctive cerebral perfusion with continuous cardiopulmonary bypass (CPB) gradually has become more popular with a view to reduce the complications related to DHCA. In addition, better neuromonitoring and neuroprotective strategies have made DHCA much safer. However, the level of evidence to support the best way to protect the brain during congenital heart surgery is insufficient. This review analyzes the history, physiology, techniques of DHCA, as well as other alternative strategies like selective cerebral perfusion and presents the current available evidence.
在先天性心脏病手术中，使用全循环停搏（TCA）/深低温循环停搏（DHCA）作为一种支持方式是经过时间考验的策略。然而，随着技术进步，该技术的广泛应用有所减少。为了减少与DHCA相关的并发症，采用持续心肺转流（CPB）进行辅助脑灌注逐渐变得更受欢迎。此外，更好的神经监测和神经保护策略使DHCA更加安全。然而，支持在先天性心脏病手术期间保护大脑的最佳方法的证据水平不足。本综述分析了DHCA的历史、生理学、技术，以及其他替代策略，如选择性脑灌注，并展示了当前可用的证据。
