Rukosujew Andreas, Motekallemi Arash, Wisniewski Konrad, Weber Raluca, De Torres-Alba Fernando, Ibrahim Abdulhakim, Weiss Raphael, Martens Sven, Dell'Aquila Angelo Maria
Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Münster, Germany.
Department of Cardiology, University Hospital Muenster, 48149 Münster, Germany.
J Clin Med. 2022 May 10;11(10):2698. doi: 10.3390/jcm11102698.
The extent of aortic replacement for aneurysms of the distal ascending aorta remains controversial and opinions vary between standard cross-clamp resection and open hemiarch anastomosis in circulatory arrest and selective cerebral perfusion. As the deleterious effects of extended circulatory arrest are well-known, borderline indication for distal ascending aorta aneurysm repair must be outweighed against the potential risk of complications related to the open anastomosis. In the present study, we describe our own approach consisting of "transversal arch clamping" for exhaustive resection of aneurysms of the distal ascending aorta without open anastomosis and we present the postoperative outcomes.
Between May 2017 and December 2019, 35 patients with aneurysm of the ascending aorta (20 male, 15 female) underwent replacement with repair of the lesser curvature without circulatory arrest. Pre-operative, intraoperative, and postoperative clinical outcomes were retrospectively withdrawn from our institutional database and analyzed.
Maximal diameter of distal ascending aorta was 47.5 mm. Patient median age was 66 years (IQR 14) (range 42-86). Preoperative logistic median EuroSCORE II was 17% (IQR 11.3). Median duration of cardiopulmonary bypass and cardiac arrest were 137 (IQR 64) and 93 (IQR 59) min, respectively. In-hospital and 30-day mortality were 0%. There were no cases with acute low output syndrome, surgical re-exploration for bleeding, kidney injury requiring dialysis, or wound infection. Disabling stroke was observed in one patient (2.9%). There was one case of major ventricular arrhythmia (2.9%).
Our institutional experience suggests that this novel technique is safe and feasible. It facilitates complete resection of the aortic ascending aneurysm avoiding circulatory arrest, antegrade cerebral perfusion, additional peripheral cannulation, and all related complications.
对于升主动脉远端动脉瘤的主动脉置换范围仍存在争议，在标准的交叉钳夹切除与在循环骤停和选择性脑灌注下进行开放半弓吻合术之间存在不同观点。由于延长循环骤停的有害影响是众所周知的，升主动脉远端动脉瘤修复的临界指征必须与开放吻合术相关并发症的潜在风险进行权衡。在本研究中，我们描述了我们自己的方法，即采用“横向弓部钳夹”，在不进行开放吻合的情况下彻底切除升主动脉远端动脉瘤，并展示术后结果。
2017年5月至2019年12月期间，35例升主动脉瘤患者（20例男性，15例女性）在不进行循环骤停的情况下接受了小弯修复置换术。术前、术中和术后的临床结果从我们机构的数据库中进行回顾性提取并分析。
升主动脉远端最大直径为47.5毫米。患者中位年龄为66岁（四分位间距14）（范围42 - 86岁）。术前逻辑中位欧洲心脏手术风险评估系统II为17%（四分位间距11.3）。体外循环和心脏骤停的中位持续时间分别为137（四分位间距64）和93（四分位间距59）分钟。住院期间和30天死亡率均为0%。没有急性低心排血量综合征、因出血进行手术再次探查、需要透析的肾损伤或伤口感染的病例。1例患者（2.9%）出现致残性中风。有1例严重室性心律失常（2.9%）。
我们机构的经验表明，这种新技术是安全可行的。它有助于完整切除升主动脉瘤，避免循环骤停顺行性脑灌注、额外的外周插管以及所有相关并发症。
