Watanabe N, Maekawa M, Nakas A, Ookawa Y, Tanaka A, Satoh T, Umami T
Department of Cardiovascular Surgery, Sapporo City General Hospital, Japan.
Kyobu Geka. 1995 Mar;48(3):217-20.
Five patients with aneurysm involving distal aortic arch underwent graft replacement of distal aortic arch and, in two patients, reconstruction of left subclavian artery through standard left postero-lateral thoracotomy with hypothermic retrograde cerebral perfusion. Retrograde cerebral perfusion with oxygen saturated venous blood could be performed by simply elevating central venous pressure to 20-23 mmHg in the Trendelenburg position and under controlling venous drainage from PA during deep hypothermic (19 degrees C) perfusion of the lower half of the body with the descending aorta occluded. Cardioplegia was induced by administration of cold blood cardioplegic solution into coronary circulation through Foley balloon catheter wedged in ascending aorta. Retrograde cerebral perfusion time was 30-77 min (mean 55 +/- 17 min), and pump time was 156-193 min (mean 168 +/- 15 min). There were no complications neurologically. In conclusion, this method rendered surgical repair of distal aortic arch aneurysm through left postero-lateral thoracotomy with both cerebral and cardiac protection able. Since any clamping of aortic arch and its branch was not necessary during above surgical procedure, cerebral emboli due to atheroma or luminal thrombus in aortic arch was prevented.
5例累及主动脉弓远端的动脉瘤患者接受了主动脉弓远端移植置换术，其中2例患者通过标准左后外侧开胸术并采用低温逆行脑灌注重建左锁骨下动脉。在深低温（19℃）下阻断降主动脉并对身体下半部进行灌注时，只需在头低脚高位将中心静脉压升高至20 - 23 mmHg并控制肺动脉的静脉引流，即可用氧饱和静脉血进行逆行脑灌注。通过楔入升主动脉的Foley球囊导管向冠状动脉循环中注入冷血心脏停搏液来诱导心脏停搏。逆行脑灌注时间为30 - 77分钟（平均55±17分钟），体外循环时间为156 - 193分钟（平均168±15分钟）。在神经方面没有并发症。总之，该方法使得通过左后外侧开胸术对主动脉弓远端动脉瘤进行手术修复并同时实现脑和心脏保护成为可能。由于在上述手术过程中无需对主动脉弓及其分支进行任何钳夹，因此可预防因主动脉弓粥样硬化或管腔内血栓形成导致的脑栓塞。
