Saran Nishant, Pochettino Alberto
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Card Surg. 2021 May;36(5):1793-1798. doi: 10.1111/jocs.15456. Epub 2021 Mar 17.
Type A aortic dissection most often requires emergent surgery to prevent malperfusion, stroke, and/or rupture of aorta. To achieve the structural goals of the operation, the conduct of the surgery is targeted from it inception at restoring true lumen flow. In this regard, institution of cardiopulmonary bypass and circulation management is key to allow adequate systemic flow, perfusion of brain and visceral organs and comprehensive systemic cooling to achieve circulatory arrest when needed. Different strategies have been used to establish adequate true lumen perfusion with varying success rates, with the most common still being femoral cannulation. More recently axillary and central cannulation strategies have shown satisfactory results by allowing more reliable true lumen flow. Cannulation approach should, therefore, depend on individual patient characteristics, presentation, and true lumen anatomy.
A型主动脉夹层通常最常需要紧急手术以预防主动脉的灌注不良、中风和/或破裂。为实现手术的结构目标，手术从一开始就旨在恢复真腔血流。在这方面，建立体外循环和循环管理是关键，以确保足够的全身血流、脑和内脏器官的灌注，并在需要时进行全面的全身降温以实现循环停止。已采用不同策略来建立足够的真腔灌注，成功率各不相同，最常用的仍是股动脉插管。最近，通过实现更可靠的真腔血流，腋动脉和中心插管策略已显示出令人满意的结果。因此，插管方法应取决于患者的个体特征、临床表现和真腔解剖结构。
