Zalaquett R, Irarrázaval M J, Morán S, Muñoz C, Garayar B, Becker P, Canessa R, Lema G, Medal J, Urzúa J
Departamento de Enfermedades Cardiovasculares, Universidad Católica de Chile, Santiago.
Rev Med Chil. 1995 Dec;123(12):1489-98.
Between May 1993 and August 1994, 15 patients (10 men) with type A aortic dissection (9 acute) had a replacement of the ascending aorta and/or aortic arch with circulatory arrest with profound hypothermia and retrograde cerebral perfusion. Mean circulatory arrest time was 47.5 min (range 23 to 68 min). Three patients (20%) died in relation to postoperative bleeding. No patient had a new neurologic damage related to surgery. Ten patients were awake and oriented before 24 hours of the operation and another one before 48 hours; 4 patients required more than 48 hours to be completely awake and oriented. Two patients were operated on with a recent stroke. One of them recovered without sequelae before hospital discharge and the other one had a major regression of his brain damage. Two other patients had emergency surgery because of cardiac tamponade and cardiogenic shock. Both of them had a satisfactory recovery. Six patients presented azotemia but only 2 of them needed dialysis. There was no case of Q wave infarction nor congestive heart failure in the perioperative period. Follow-up was 100% completed (12 patients) with a mean of 9.8 months (range 5 to 18 months). One patient died on the 10th postoperative month because of a late infectious process. Eight patients are in functional class I and 3 in II. Ten of them are back to their usual activities'. Although retrograde cerebral perfusion is a new surgical technique, it seems to be a very valuable complement for brain protection in ascending aorta and/or aortic arch surgery with circulatory arrest with profound hypothermia.
1993年5月至1994年8月期间，15例A型主动脉夹层患者（10例男性）接受了升主动脉和/或主动脉弓置换术，术中采用深低温停循环及逆行脑灌注。平均停循环时间为47.5分钟（范围23至68分钟）。3例患者（20%）死于术后出血。无患者因手术出现新的神经损伤。10例患者在术后24小时内清醒且定向力恢复，另1例在48小时内恢复；4例患者需要超过48小时才能完全清醒并恢复定向力。2例患者术前近期有中风发作。其中1例在出院前康复且无后遗症，另1例脑损伤有明显好转。另外2例患者因心脏压塞和心源性休克接受急诊手术。二者均恢复良好。6例患者出现氮质血症，但仅2例需要透析。围手术期无Q波梗死及充血性心力衰竭病例。随访100%完成（12例患者），平均随访9.8个月（范围5至18个月）。1例患者在术后第10个月因晚期感染过程死亡。8例患者心功能为I级，3例为II级。其中10例已恢复日常活动。尽管逆行脑灌注是一种新的手术技术，但在深低温停循环下行升主动脉和/或主动脉弓手术时，它似乎是一种非常有价值的脑保护补充措施。
