Schepens M A, Defauw J J, Hamerlijnck R P, Vermeulen F E
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Ann Vasc Surg. 1995 Jul;9(4):327-38. doi: 10.1007/BF02139403.
The purpose of this study was to assess the usefulness of left heart bypass in thoracoabdominal aortic aneurysm surgery. Data from 50 patients who underwent thoracoabdominal aortic aneurysm repair between July 1987 and October 1993 were retrospectively reviewed. In all of them a left heart bypass (left atrium to left femoral artery) with a centrifugal pump (without systemic heparinization) was used. Patient-, disease-, and operation-related variables were analyzed using univariate methods. There were no intraoperative deaths. The in-hospital mortality rate was 8% (n = 4). Survival rates were 77% (+/- 6.5) at 2 years and 62% (+/- 8.7) at 5 years. Renal failure requiring dialysis occurred in five (10%) patients and paraplegia in five (10%). Sixteen (32%) patients had respiratory insufficiency requiring prolonged (> 8 days) ventilation. After univariate analysis, the risk factors for developing a need for postoperative dialysis were found to be the preoperative creatinine level (p = 0.002) and the presence of preoperative arterial hypertension (p = 0.018). A history of peripheral vascular occlusive disease (p = 0.008) was an important risk factor for predicting late death. No factors retained significance in the univariate analysis of hospital deaths and postoperative paraplegia. Renal and spinal ischemic times were substantially reduced in comparison to the theoretic times calculated if cross-clamping had been used. Bypass-related complications were completely absent. The use of a left heart bypass during thoracoabdominal aortic aneurysm surgery may not reduce the global complication rate; the results were similar to those achieved using simple cross-clamping. However, this technique appears to be the method of choice for protecting organ systems at risk during difficult repairs.
本研究的目的是评估左心转流在胸腹主动脉瘤手术中的实用性。对1987年7月至1993年10月期间接受胸腹主动脉瘤修复术的50例患者的数据进行了回顾性分析。所有患者均使用带离心泵的左心转流（从左心房至左股动脉）（未进行全身肝素化）。采用单变量方法分析患者、疾病和手术相关变量。术中无死亡病例。住院死亡率为8%（n = 4）。2年生存率为77%（±6.5），5年生存率为62%（±8.7）。5例（10%）患者发生需要透析的肾衰竭，5例（10%）患者发生截瘫。16例（32%）患者出现呼吸功能不全，需要长时间（> 8天）通气。单变量分析后发现，术后需要透析的危险因素为术前肌酐水平（p = 0.002）和术前动脉高血压（p = 0.018）。外周血管闭塞性疾病史（p = 0.008）是预测晚期死亡的重要危险因素。在医院死亡和术后截瘫的单变量分析中，没有因素具有显著意义。与使用交叉钳夹计算的理论时间相比，肾和脊髓缺血时间大幅缩短。完全没有与转流相关的并发症。在胸腹主动脉瘤手术中使用左心转流可能不会降低总体并发症发生率；结果与使用简单交叉钳夹相似。然而，在困难修复过程中，这种技术似乎是保护有风险的器官系统的首选方法。
