Ehrlich M, Grabenwöger M, Luckner D, Cartes-Zumelzu F, Simon P, Laufer G, Wolner E, Havel M
Department of Cardio-Thoracic Surgery, University of Vienna, Austria.
Eur J Cardiothorac Surg. 1997 Jan;11(1):176-81. doi: 10.1016/s1010-7940(96)01026-3.
This retrospective study reviews the contemporary surgical outcome of our patients undergoing operations on thoracic aneurysms in deep hypothermic circulatory arrest.
Between January 1989 and February 1995, 279 patients were operated on in our institution on various portions of the aorta. In 143 patients (97 male, 46 female), deep hypothermia and circulatory arrest were used as the standard operative technique. Patients age ranged from 16 to 83 years (mean 55). Final indication for operation was dissection Type A in 80 patients (61 acute, 19 chronic), dissection Type B in 21 patients (17 acute, 4 chronic) and atherosclerotic aneurysms in 42 patients (11 acute, 31 chronic). 16 patients were operated under preoperative unstable hemodynamic conditions, 6 patients had been resuscitated preoperatively. Surgical technique included cardiopulmonary bypass with femoral artery cannulation. For added cerebral protection all patients received Cortisone and barbiturates right before circulatory arrest (confirmed by 0-EEG). The segment of the aorta containing the area with the aneurysm, was resected and replaced with a tubular albumin coated graft.
The 30-day mortality was 31.15% (19/61) in the acute and 23.52% (4/19) in the chronic type A dissection group, 35.29% (6/17) in the acute and 25% (1/4) in the chronic type B group, 36.3% (4/11) in the acute and 22.58% (7/31) in the chronic atherosclerotic group. Causes of postoperative death in order of frequency were: multiorgan failure (n = 15), myocardial failure (n = 13), bleeding (n = 4), sepsis (n = 4), myocardial infarction (n = 3) and stroke (n = 2).
Despite rather high mortality rates in the acute aneurysm groups, the technique of profound hypothermic circulatory arrest represents a relatively safe method for operations on the thoracic aorta.
本回顾性研究评估了我院在深低温循环停搏下对胸主动脉瘤患者进行手术的当代手术效果。
1989年1月至1995年2月期间，我院对279例患者的不同主动脉段进行了手术。其中143例患者（97例男性，46例女性）采用深低温循环停搏作为标准手术技术。患者年龄在16至83岁之间（平均55岁）。手术的最终适应证为：80例A型夹层（61例急性，19例慢性），21例B型夹层（17例急性，4例慢性），42例动脉粥样硬化性动脉瘤（11例急性，31例慢性）。16例患者在术前血流动力学不稳定的情况下接受手术，6例患者术前曾接受复苏。手术技术包括股动脉插管的体外循环。为了加强脑保护，所有患者在循环停搏前（经脑电图确认）均接受了可的松和巴比妥类药物。切除包含动脉瘤区域的主动脉段，并用管状白蛋白涂层移植物进行置换。
急性A型夹层组30天死亡率为31.15%（19/61），慢性A型夹层组为23.52%（4/19）；急性B型夹层组为35.29%（6/17），慢性B型夹层组为25%（1/4）；急性动脉粥样硬化组为36.3%（4/11），慢性动脉粥样硬化组为22.58%（7/31）。术后死亡原因按频率依次为：多器官功能衰竭（n = 15）、心肌衰竭（n = 13）、出血（n = 4）、败血症（n = 4）、心肌梗死（n = 3）和中风（n = 2）。
尽管急性动脉瘤组死亡率较高，但深低温循环停搏技术仍是一种相对安全的胸主动脉手术方法。
