Ishida Keiichi, Kohno Hiroki, Matsuura Kaoru, Watanabe Michiko, Sugiura Toshihiko, Jujo Sanada Takayuki, Naito Akira, Shigeta Ayako, Suda Rika, Sekine Ayumi, Masuda Masahisa, Sakao Seiichiro, Tanabe Nobuhiro, Tatsumi Koichiro, Matsumiya Goro
Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
Department of Respirology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.
Surg Today. 2023 Mar;53(3):369-378. doi: 10.1007/s00595-022-02573-w. Epub 2022 Aug 26.
Neurologic adverse events (NAEs) are a major complication after pulmonary endarterectomy (PEA) performed under periods of deep hypothermic circulatory arrest (HCA) for chronic thromboembolic pulmonary hypertension. We modified the PEA strategy to prevent NAEs and evaluated the effectiveness of these modifications.
We reviewed the surgical outcomes of 87 patients divided into the following three groups based on the surgical strategy used: group S (n = 49), periods of deep HCA with alpha-stat strategy; group M1 (n = 19), deep HCA with modifications of slower cooling and rewarming rates and the pH-stat strategy for cooling: and group M2 (n = 13), multiple short periods of moderate HCA.
PEA provided significant improvement of pulmonary hemodynamics in each group. Sixteen (29%) of the 49 group S patients suffered NAEs, associated with total circulatory arrest time (cutoff, 57 min) and Jamieson type I disease. The Group M1 and M2 patients did not suffer NAEs, although the group M1 patients had prolonged cardiopulmonary bypass (CPB) and more frequent respiratory failure.
NAEs were common after PEA performed under periods of deep HCA. The modified surgical strategy could decrease the risk of NAEs but increase the risk of respiratory failure. Multiple short periods of moderate HCA may be useful for patients at risk of NAEs.
对于慢性血栓栓塞性肺动脉高压患者，在深度低温循环停搏（HCA）期间进行肺内膜剥脱术（PEA）后，神经系统不良事件（NAEs）是一种主要并发症。我们对PEA策略进行了改良以预防NAEs，并评估这些改良措施的有效性。
我们回顾了87例患者的手术结果，根据所采用的手术策略将患者分为以下三组：S组（n = 49），采用α-stat策略的深度HCA期；M1组（n = 19），深度HCA期，采用较慢的降温及复温速率以及降温时的pH-stat策略；M2组（n = 13），多次短时间的中度HCA。
PEA使每组患者的肺血流动力学均得到显著改善。49例S组患者中有16例（29%）发生NAEs，与总循环停搏时间（临界值，57分钟）及Jamieson I型疾病相关。M1组和M2组患者未发生NAEs，尽管M1组患者的体外循环（CPB）时间延长且呼吸衰竭更为频繁。
在深度HCA期间进行PEA后，NAEs很常见。改良的手术策略可降低NAEs风险，但会增加呼吸衰竭风险。多次短时间的中度HCA可能对有NAEs风险的患者有用。
