López Gómez A, Rodríguez R, Zebdi N, Ríos Barrera R, Forteza A, Legarra Calderón J J, Garrido Martín P, Hernando B, Sanjuan A, González Bardanca S, Varela Martínez M Á, Fernández F E, Llorens R, Valera Martínez F J, Gómez Felices A, Aranda Granados P J, Sádaba Sagredo R, Echevarría J R, Vicente Guillén R, Silva Guisasola J
Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Servicio de Cirugía Cardiaca, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Rev Esp Anestesiol Reanim (Engl Ed). 2022 Mar;69(3):143-178. doi: 10.1016/j.redare.2021.02.010. Epub 2022 Mar 12.
Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended.
主动脉疾病对于临床医生而言始终是一项挑战，鉴于所使用资源的技术复杂性，必须由多学科团队进行诊断和治疗。目前，各方不断努力实施一种系统的、规范化的方法，组建由心脏病专家、心脏外科医生、血管外科医生、麻醉师和放射科医生等组成的“主动脉团队”，这正带来更好的治疗效果。这份由西班牙麻醉学、复苏与疼痛治疗学会（SEDAR）和西班牙胸心血管外科学会（SECTCV）的主动脉工作组起草的共识文件，旨在推广一套工作方案。欧洲心胸外科学会（EACTS）和欧洲血管外科学会（ESVS）的最新共识文件对“主动脉团队”的概念进行了定义(1)。主动脉团队应从诊断到治疗，最终到随访全程密切参与，应由心脏外科医生和血管外科医生与麻醉师、心脏病专家、放射科医生和遗传学家共同组成。主动脉疾病的治疗应集中在大型中心，因为这是有效了解疾病自然病程、一站式提供所有治疗选择并处理潜在并发症的唯一途径。必须具备简化的紧急护理途径（全天候可用）、足够的转运能力，以及多学科团队的快速启动机制。鉴于治疗选择的复杂性和不断演变，我们推出这份升主动脉和主动脉弓手术的麻醉学与外科学指南的第一版。无疑仍会有一些问题未得到解答，未来版本将纳入一些虽已在某些中心实施，但仍未被广泛推荐的新技术。
