Alhussaini Mahmoud, Falasa Matheus P, Jeng Eric I, Martin Tomas, Becker Torben K, Arnaoutakis George J, Fillion Amber, Neal Dan, Beaver Thomas M
Cardiothoracic Surgery Department, Assiut University, Assiut, Egypt.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Fla.
J Thorac Cardiovasc Surg. 2023 Apr;165(4):1275-1280. doi: 10.1016/j.jtcvs.2021.03.080. Epub 2021 Mar 31.
Deep hypothermic circulatory arrest (DHCA) is often required for patients undergoing repair of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm via left thoracotomy when proximal crossclamping is not feasible or when aneurysmal disease extends into the transverse aortic arch. Historical literature suggests higher complications rates due to the technical complexity of this approach; we examined outcomes with this approach at our center.
Between January 2008 and May 2018, 84 patients with DTAA or Crawford extent I thoracoabdominal aortic aneurysm underwent open repair. DHCA was employed in 46 of 84 (55%) patients, of which 33 (72%) required repair of distal arch and DTAA, and 13 (28%) required repair of the distal arch and extent I thoracoabdominal aortic aneurysm. Patients who underwent DHCA had more chronic dissections than those in the non-DHCA group (70% vs 34%; P ≤ .05).
Major adverse outcomes for the DHCA group versus non-DHCA group were as follows: early mortality 3 out of 46 (7%) versus 4 out of 38 (11%) (P = .70), stroke 3 out of 46 (7%) versus 1 out of 38 (3%) (P = .62), permanent spinal cord deficit 2 out of 46 (4%) versus 3 out of 38 (8%) (P = .65), permanent renal failure necessitating dialysis 1 out of 46 (2%) versus 2 out of 38 (5%) (P = .59). Freedom from major adverse outcomes was 38 out of 46 (83%) versus 31 out of 38 (82%) for DHCA versus non-DHCA (P = 1).
DHCA can be employed via left thoracotomy for combined arch and DTAA or extent I thoracoabdominal aortic aneurysm open repair.
对于经左胸切口行降胸主动脉瘤（DTAA）或胸腹主动脉瘤修复术的患者，当近端阻断不可行或动脉瘤性疾病延伸至主动脉弓横部时，常需要进行深低温停循环（DHCA）。历史文献表明，由于该方法技术复杂，并发症发生率较高；我们在本中心研究了该方法的治疗效果。
2008年1月至2018年5月，84例DTAA或克劳福德I型胸腹主动脉瘤患者接受了开放修复术。84例患者中有46例（55%）采用了DHCA，其中33例（72%）需要修复主动脉弓远端和DTAA，13例（28%）需要修复主动脉弓远端和I型胸腹主动脉瘤。接受DHCA的患者比非DHCA组有更多的慢性夹层（70%对34%；P≤0.05）。
DHCA组与非DHCA组的主要不良结局如下：早期死亡率46例中有3例（7%），而38例中有4例（11%）（P = 0.70）；卒中46例中有3例（7%），而38例中有1例（3%）（P = 0.62）；永久性脊髓损伤46例中有2例（4%），而38例中有3例（8%）（P = 0.65）；需要透析的永久性肾衰竭46例中有1例（2%），而38例中有2例（5%）（P = 0.59）。DHCA组与非DHCA组无主要不良结局的比例分别为46例中的38例（83%）和38例中的31例（82%）（P = 1）。
DHCA可通过左胸切口用于联合主动脉弓和DTAA或I型胸腹主动脉瘤的开放修复。
