Watanabe S, Hayashi K, Yamanishi H, Tomioka H, Minami M, Shindoh N, Miyamoto K
Department of Cardiovascular Surgery, Hokko Cardiovascular Hospital, Sapporo, Japan.
Artif Organs. 1997 Jul;21(7):846-51. doi: 10.1111/j.1525-1594.1997.tb03755.x.
Graft replacement of the descending thoracic or thoracoabdominal aorta was successfully performed in 3 patients using percutaneous cardiopulmonary bypass. Femoral inflow and outflow cannulas were inserted percutaneously after induction of anesthesia with the patient in supine position, and low flow normothermic bypass was established before thoracotomy. Next the patient was placed in a right lateral position to create an operating field. With this body position and even an almost prone position, which was sometimes necessary for easy dissection of adhesion of lung to the aneurysmal wall, the bypass flow was easily maintained adequately. The bypass circuit was coated with heparin, and the activated clotting time (ACT) was controlled to be between 150 and 200 s during the entire operating period. Percutaneous insertion of the cannulas avoided local bleeding in the groin, and the low ACT made control of hemorrhage in the operating field easy. For descending aortic surgery, heparin-coated percutaneous cardiopulmonary bypass proved to be a useful adjunctive measure.
3例患者采用经皮心肺转流术成功实施了降胸段或胸腹段主动脉移植术。在患者仰卧位麻醉诱导后经皮插入股动静脉插管，在开胸术前建立低流量常温体外循环。接着将患者置于右侧卧位以形成手术视野。采用这种体位，甚至有时采用几乎俯卧的体位（这对于轻松分离肺与动脉瘤壁的粘连有时是必要的），都能轻松维持足够的体外循环流量。体外循环回路涂有肝素，在整个手术期间将活化凝血时间（ACT）控制在150至200秒之间。经皮插入插管避免了腹股沟局部出血，低ACT使得术野出血易于控制。对于降主动脉手术，肝素涂层经皮心肺转流术被证明是一种有用的辅助措施。
