Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Heart Surg Forum. 2021 Jul 29;24(4):E675-E679. doi: 10.1532/hsf.3879.
The hypothermic circulatory arrest (HCA) is an indispensable step in the surgical treatment of an acute type A aortic dissection (ATAAD), which could greatly affect the postoperative outcome. We modified the HCA technique and validated the feasibility and superiority of the new approach relative to the conventional method.
Eighty-eight patients with ATAAD were enrolled in this study between May 2016 and April 2018. Of those, 36 patients in the Conventional treatment group had circulatory arrest at 25°C for about 16-28 minutes, while 52 patients in the Modification group underwent a circulatory arrest at 28°C for only 1-3 minutes. The preoperative clinical data and postoperative clinical outcomes were compared between the two groups. No intraoperative mortality occurred in any of the cases. No significant differences were observed in the aortic cross-clamp times during the cardiopulmonary bypass (CPB) between the two groups. In the Modification group, several indicators, such as mechanical ventilation time, postoperative 48-h drainage volume, blood transfusion volume, the ICU-stay time and postoperative hospital stay, were reduced significantly as compared with those in the Conventional group. Whereas three postoperative deaths in the hospital occurred in the Conventional treatment group, all the patients in the Modification group were cured. There is no difference in the incidence of postoperative complications between the two groups. The patients had a 100% follow up with a mean of 17 ± 6 months.
A moderate hypothermia with a short circulatory arrest is a safe and effective HCA approach that provides satisfactory early and near-midterm results in the patients who received ATAAD treatment.
低温停循环（HCA）是急性 A 型主动脉夹层（ATAAD）手术治疗中不可或缺的步骤，这对术后结果有很大影响。我们修改了 HCA 技术，并验证了新方法相对于传统方法的可行性和优越性。
本研究纳入了 2016 年 5 月至 2018 年 4 月期间 88 例 ATAAD 患者。其中，常规治疗组 36 例患者在 25°C 下停循环约 16-28 分钟，而改良组 52 例患者在 28°C 下仅停循环 1-3 分钟。比较两组患者的术前临床资料和术后临床结局。所有病例术中均无死亡。两组体外循环（CPB）期间主动脉阻断时间无显著差异。改良组机械通气时间、术后 48 小时引流量、输血量、住 ICU 时间和术后住院时间均明显减少。而常规治疗组有 3 例术后院内死亡，改良组所有患者均治愈。两组术后并发症发生率无差异。患者的随访率为 100%，平均随访时间为 17±6 个月。
中低温短停循环是一种安全有效的 HCA 方法，可为接受 ATAAD 治疗的患者提供满意的早期和近中期结果。
