Kuniyoshi Y, Koja K, Iha K, Akasaki M, Miyagi K, Shimoji M, Kudaka M, Kusaba A
Second Department of Surgery, University of the Ryukyus, Okinawa, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Jan;44(1):19-24.
We treated three cases of ascending-arch-descending aortic aneurysm with annuloaortic ectasia by performing graft replacement. The patients included a 34 year old female, a 34 year old male and a 42 year old male. In one case the aneurysm was atherosclerotic and of type I and II + IIIb dissection in the other two cases. During the operation we were able to utilize normothermic selective cerebral perfusion during construction of the left common carotid artery. Specially, normothermic partial F-F bypass and normothermic selective cerebral perfusion to the left common carotid artery were used during graft replacement from the descending aorta to the left common carotid artery. This was followed by regular hypothermic total ECC and hypothermic cerebral selective perfusion during subsequent graft replacement of the innominate artery and a modified Bentall's operation. This new protocol in which normothermic cerebral perfusion is utilized during the procedure on the left common carotid artery and hypothermic perfusion is utilized only during the subsequent procedure on the innominate artery permits significant shortening of the cardiac arrest time and cerebral perfusion time compared with when only hypothermic perfusion is used. This significant shortening contains obvious benefits in the areas of cardiac and brain protection.
我们对三例升主动脉-降主动脉瘤合并主动脉瓣环扩张的患者进行了人工血管置换术。患者包括一名34岁女性、一名34岁男性和一名42岁男性。其中一例动脉瘤为动脉粥样硬化性，另外两例为I型和II + IIIb型夹层。手术过程中，在构建左颈总动脉时我们能够采用常温选择性脑灌注。具体而言，在从降主动脉到左颈总动脉的人工血管置换过程中，采用了常温部分F-F旁路和对左颈总动脉的常温选择性脑灌注。随后在无名动脉的后续人工血管置换和改良Bentall手术期间，采用常规低温全身体外循环和低温脑选择性灌注。与仅使用低温灌注相比，这种在左颈总动脉手术过程中采用常温脑灌注、仅在无名动脉后续手术过程中采用低温灌注的新方案，可显著缩短心脏停搏时间和脑灌注时间。这种显著缩短在心脏和脑保护方面具有明显益处。
