Murata S, Adachi H, Mizuhara A, Yamaguchi A, Kamio H, Ino T
Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Jan;44(1):9-13.
Open proximal anastomosis under hypothermic circulatory arrest was applied to eleven consecutive patients with descending aortic diseases. These patients included five aortic dissections and six thoracic aortic aneurysms. Fourth and 7th intercostal spaces were opened by left posterolateral thoracotomy. Cardiopulmonary bypass was established by right atrial drainage via femoral vein and main pulmonary artery. Arterial blood was perfused via femoral artery. The descending aorta was opened under hypothermic circulatory arrest with anal temperature of 20 degrees C, and the anastomosis of the proximal site of the graft was performed with bloodless field. After the proximal anastomosis was finished, the main graft was clamped and perfused via the branch of the graft. The distal anastomosis was performed during circulatory arrest of the lower body. Mean circulatory arrest time of the upper body was 31 min, and that of the lower body was 37 min. Nine of the patients arrive without any major complications, but two of them died due to postoperative low cardiac output syndrome and postoperative pneumonia. Open proximal anastomosis under hypothermic circulatory arrest may be useful for the replacement of the diseased descending aorta due to dissection or aortic aneurysm with mural thrombi because of the advantage of non-clamping anastomosis with bloodless surgical field.
对11例连续性降主动脉疾病患者采用低温循环停止下的开放性近端吻合术。这些患者包括5例主动脉夹层和6例胸主动脉瘤。通过左后外侧开胸术打开第四和第七肋间间隙。通过股静脉和主肺动脉进行右心房引流建立体外循环。动脉血通过股动脉灌注。在体温降至20℃的低温循环停止下打开降主动脉，并在无血视野下进行移植物近端部位的吻合。近端吻合完成后，夹住主移植物并通过移植物分支进行灌注。在下半身循环停止期间进行远端吻合。上半身平均循环停止时间为31分钟，下半身平均循环停止时间为37分钟。9例患者术后无任何重大并发症，但其中2例因术后低心排血量综合征和术后肺炎死亡。由于低温循环停止下的开放性近端吻合术具有无钳夹吻合和无血手术视野的优点，可能对因夹层或伴有附壁血栓的主动脉瘤而病变的降主动脉置换术有用。
