Nishiwaki N, Kawano Y, Suenaga E, Ikeda K
Department of Cardiovascular Surgery, Fukuoka Tokushukai Hospital, Japan.
Kyobu Geka. 1994 Oct;47(11):892-4.
Between August 1991 and November 1993, five patients underwent total aortic arch graft replacement in a manner which placed emphasis on myocardial protection. All operations were performed with the use of extracorporeal circulation and selective cerebral perfusion. Oxygenated warm blood was infused at a flow rate of 300 ml/min. via a catheter inserted proximal to the site of occlusion of the ascending aorta or replaced graft of the ascending aorta. After the beating of the heart was resumed under left venting, aortic arch was replaced using a prosthetic graft with three branches. Concomitant operations were reconstructions of the aortic root with composite graft (Bentall's technique) in two patients of Marfan's syndrome and type A aortic dissection. All patients were easily taken off cardiopulmonary bypass and postoperative course was uneventful. We believe that shortening of the duration of ischemic cardiac arrest is important if surgical results of total aortic arch replacement are to be further improved, above all in patients at high risk for surgery, such as elderly subjects whose organ function is often compromised.
1991年8月至1993年11月期间，5例患者接受了全主动脉弓移植置换术，手术重点在于心肌保护。所有手术均在体外循环和选择性脑灌注下进行。通过插入升主动脉闭塞部位近端或升主动脉置换移植物近端的导管，以300 ml/min的流速输注氧合温血。在左心引流下心脏恢复跳动后，使用带三个分支的人工血管置换主动脉弓。在2例马方综合征和A型主动脉夹层患者中，同期手术采用复合移植物（Bentall技术）重建主动脉根部。所有患者均顺利脱离体外循环，术后病程平稳。我们认为，若要进一步提高全主动脉弓置换术的手术效果，缩短心脏缺血性停搏时间至关重要，尤其是对于手术风险高的患者，如器官功能常受损的老年患者。
