Division of Thoracic and Caridovascular Surgery, University of Florida Health, Gainesville, Florida, USA.
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Card Surg. 2022 Oct;37(10):3279-3286. doi: 10.1111/jocs.16809. Epub 2022 Jul 27.
With evolutions in technique, recent data encourage the use of cerebral perfusion during aortic arch repair. However, a randomized data have demonstrated higher rates of neurologic injury according to MRI lesions using antegrade cerebral perfusion during hemiarch reconstruction.
This was a retrospective review of two institutional aortic center databases to identify adult patients who underwent aortic hemiarch reconstruction for elective aortic aneurysm or acute type A aortic dissection. Patients were stratified according to cerebral protection method: (1) deep hypothermic circulatory arrest (DHCA) group versus (2) DHCA/retrograde cerebral perfusion (RCP) group.
A total of 320 patients and 245 patients underwent hemiarch reconstruction for aortic aneurysm electively and aortic dissection, respectively. In aneurysmal pathology, the DHCA group included 133 patients and the DHCA/RCP group included 187 patients. Operative mortality was 0.8% in the DHCA group and 2.7% in the DHCA/RCP group (p = 0.41). Kaplan-Meier survival estimates revealed comparable 2-year survival (p = 0.14). In dissection, 43 patients and 202 patients were included in the DHCA group and the DHCA/RCP group, respectively. Operative mortality was equivalent between the two groups (11.6% in the DHCA group and 9.4% in the DHCA/RCP group, p = 0.58). Long-term survival was similar at 2 years between the groups (p = 0.06). Multivariable analysis showed cerebral perfusion strategy was not associated with the composite outcome of operative mortality and stroke.
In treating both elective and acute ascending aortic pathologies with hemiarch reconstruction, both DHCA alone or in combination with RCP yield comparable results.
随着技术的发展，最近的数据鼓励在主动脉弓修复期间使用脑灌注。然而，一项随机数据显示，在进行半弓重建时使用顺行性脑灌注，根据 MRI 病变，神经损伤的发生率更高。
这是对两个机构主动脉中心数据库的回顾性分析，以确定接受择期主动脉弓重建的成人患者，用于治疗主动脉弓动脉瘤或急性 A 型主动脉夹层。患者根据脑保护方法分层：（1）深低温停循环（DHCA）组与（2）DHCA/逆行性脑灌注（RCP）组。
共有 320 例患者和 245 例患者分别因主动脉瘤择期和主动脉夹层进行半弓重建。在动脉瘤病理中，DHCA 组包括 133 例患者，DHCA/RCP 组包括 187 例患者。DHCA 组的手术死亡率为 0.8%，DHCA/RCP 组为 2.7%（p=0.41）。Kaplan-Meier 生存估计显示，2 年生存率相似（p=0.14）。在夹层中，DHCA 组包括 43 例患者，DHCA/RCP 组包括 202 例患者。两组之间的手术死亡率相当（DHCA 组为 11.6%，DHCA/RCP 组为 9.4%，p=0.58）。两组 2 年的长期生存率相似（p=0.06）。多变量分析显示，脑灌注策略与手术死亡率和卒中的复合结果无关。
在使用半弓重建治疗择期和急性升主动脉病变时，DHCA 单独或与 RCP 联合使用的结果相似。
