Department of General Surgery, University of Louisville, Louisville, Kentucky.
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Tex Heart Inst J. 2024 Feb 12;51(1). doi: 10.14503/THIJ-22-8026.
Aortic aneurysms involving the proximal aortic arch, which require hemiarch-type repair, typically require circulatory arrest with antegrade cerebral perfusion. Left carotid antegrade cerebral perfusion (LCP) via distal arch cannulation without circulatory arrest was used in this study's patient population. The goal was to assess the operative efficiency and clinical outcomes of using a distal arch cannulation technique that would not require any hypothermic circulatory arrest (HCA) time compared with more traditional brachiocephalic artery cannulation with right-sided unilateral antegrade cerebral perfusion (RCP) and HCA.
A single-center retrospective review of patients with replacement of the distal ascending aorta involving the proximal arch was performed. Patients with an intramural hematoma or dissection were excluded. Between January 2015 and December 2019, 68 adult patients had undergone a hemiarch repair because of aneurysmal disease. Analysis of baseline demographics, operative data, and clinical outcomes was performed.
Comparing the 68 patients: 21 patients were treated with RCP (via brachiocephalic artery graft with HCA), and 47 patients were treated with LCP (via distal aortic arch cannulation with cross-clamp between the brachiocephalic and left common carotid arteries without HCA). Baseline characteristics and outcomes were evaluated for both groups. The LCP group was younger (LCP median [IQR] age, 60 [53-65] years vs RCP median [IQR] age, 67 [59-71] years]. Sex, race, body mass index, comorbidities, and ejection fraction were similar between the groups. Cardiopulmonary bypass time (LCP, 123 minutes vs RCP, 149 minutes) and unilateral cerebral perfusion time (LCP, 17 minutes vs RCP, 22 minutes) were longer in the RCP group. Bleeding, prolonged ventilatory support, kidney failure, and length of stay were similar. In-hospital mortality was 2% in the LCP group vs 0% in the RCP group. Stroke occurred in 2 patients (4.2%) in the LCP group and in 0% of the RCP group. Mortality at 6 months in the LCP and RCP groups was 3% and 10%, respectively.
Distal arch cannulation with LCP without HCA is a reasonable and safe alternative strategy for patients requiring hemiarch replacement for aneurysmal disease. This technique may provide additional benefits by avoiding circulatory arrest in these complex cases.
涉及近端主动脉弓的主动脉瘤需要行半弓修复术，通常需要顺行脑灌注下的循环停止。本研究的患者群体采用了通过远端弓插管的左颈动脉顺行脑灌注（LCP），而无需循环停止。目的是评估与更传统的右侧头臂动脉插管加右侧单侧顺行脑灌注（RCP）和循环停止相比，不使用任何低温循环停止（HCA）时间的远端弓插管技术的手术效率和临床结果。
对因动脉瘤病而行远端升主动脉弓置换的患者进行了单中心回顾性研究。排除了壁内血肿或夹层的患者。2015 年 1 月至 2019 年 12 月，68 例成人因动脉瘤病接受了半弓修复术。对基线人口统计学、手术数据和临床结果进行了分析。
比较这 68 例患者：21 例采用 RCP（通过头臂动脉移植物加 HCA）治疗，47 例采用 LCP（通过远端主动脉弓插管，在头臂和左颈总动脉之间加横钳，无需 HCA）治疗。对两组患者的基线特征和结果进行了评估。LCP 组更年轻（LCP 组中位数[IQR]年龄 60[53-65]岁，RCP 组中位数[IQR]年龄 67[59-71]岁）。两组的性别、种族、体重指数、合并症和射血分数相似。体外循环时间（LCP 组 123 分钟，RCP 组 149 分钟）和单侧脑灌注时间（LCP 组 17 分钟，RCP 组 22 分钟）在 RCP 组更长。出血、长时间通气支持、肾衰竭和住院时间相似。LCP 组院内死亡率为 2%，RCP 组为 0%。LCP 组有 2 例（4.2%）发生脑卒中，RCP 组无脑卒中。LCP 和 RCP 组的 6 个月死亡率分别为 3%和 10%。
对于因动脉瘤病需要行半弓置换的患者，采用不使用 HCA 的远端弓插管加 LCP 是一种合理且安全的替代策略。在这些复杂病例中，这种技术通过避免循环停止可能提供额外的益处。
