Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
J Card Surg. 2022 Nov;37(11):3984-3987. doi: 10.1111/jocs.16879. Epub 2022 Sep 1.
There are limits to the use of cardioplegic arrest during complex cardiac surgical procedures, especially in patients with severe left ventricular dysfunction. In the current report, we graphically present the detailed surgical strategy and technique for beating-heart aortic root replacement with concomitant coronary bypass grafting, for patients otherwise deemed inoperable. With support of cardiopulmonary bypass (CPB), beating-heart bypass surgery is realized, after which the bypass grafts can selectively be connected to the CPB, preserving coronary flow. Then, on the beating and perfused heart, a complex procedure such as aortic root replacement can be performed, without jeopardizing postoperative cardiac function. However, several important caveats and remarks regarding the use of beating-heart surgery should be considered, including: coronary perfusion verification and maintenance, temperature management, and prevention of air embolisms. By use of this strategy, risks associated with cardioplegic arrest are minimized, while it circumvents the potential need for long-term postoperative extracorporeal membrane oxygenation.
在复杂的心脏外科手术中，心脏停搏液的使用是有限制的，尤其是在严重左心室功能障碍的患者中。在本报告中，我们详细介绍了一种详细的手术策略和技术，用于在体外循环（CPB）支持下，对那些被认为无法手术的患者进行不停跳心脏主动脉根部置换术，并同时进行冠状动脉旁路移植术。在 CPB 支持下，实现了不停跳旁路手术，然后可以将旁路移植物选择性地连接到 CPB 上，以保持冠状动脉血流。然后，在跳动和灌注的心脏上，可以进行主动脉根部置换等复杂手术，而不会危及术后心功能。然而，在使用不停跳心脏手术时，需要考虑几个重要的注意事项和注意事项，包括：冠状动脉灌注验证和维持、温度管理和预防空气栓塞。通过使用这种策略，可以将心脏停搏相关的风险降至最低，同时避免了长期术后体外膜肺氧合的潜在需求。
