Uchida N, Watanabe S, Shinozaki S, Niibori K, Sadahiro M, Ohmi M, Tabayashi K
Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Aug;45(8):1076-83.
From 1987 to 1994, 116 patients received replacement of the ascending and/or aortic arch using selective cerebral perfusion. They were 82 male and 34 female, with average age of 64 years. There were 63 dissecting and 53 true aneurysms. Extent of replacement was: ascending aorta in 13, aortic root in 2, aortic arch in 93, and aortic root and complete arch in 8. Aortic arch replacements were composed of: 29 partial proximal aortic arch replacements, 44 complete aortic arch replacements, and 20 partial distal aortic arch replacements. Nineteen (16.4%) hospital deaths occurred. Univariate testing of pre-, intra-, and post-operative variables followed by stepwise logistic regression analyses identified elderly, ischemic heart disease, postoperative neurologic complication, cardiac dysfunction, renal failure, and massive bleeding as factors having independent association with hospital mortality. Neurologic complication was found in 10 patients (8.6%), and risk factor for this complication was preoperative peripheral vascular disease. Follow-up of hospital survivors documented an overall cumulative 5-year survive rate of 69%. There was no significant difference between dissection and true aneurysms in 5-year survive ratios, which were 63% and 82%, respectively. During follow-up periods, 18 patients died. Half of these cases were vascular deaths, caused by rupture, sudden death and secondary operation. Univariate analyses followed by stepwise Cox testing indicated that chronic obstructive pulmonary disease and a history of postoperative massive bleeding were associated with decreased later survival. Our experience suggests that selective cerebral perfusion is a safe technique for the repair of ascending aorta and/or aortic arch problems. High-risk subgroups of patients with these aortic problems can be identified by risk factors. Aggressive and careful management is necessary for such subgroups to improve early and late survival rates.
1987年至1994年期间，116例患者接受了采用选择性脑灌注技术的升主动脉和/或主动脉弓置换术。其中男性82例，女性34例，平均年龄64岁。包括63例夹层动脉瘤和53例真性动脉瘤。置换范围为：升主动脉13例，主动脉根部2例，主动脉弓93例，主动脉根部及全弓8例。主动脉弓置换术包括：29例部分近端主动脉弓置换术，44例全主动脉弓置换术，20例部分远端主动脉弓置换术。19例（16.4%）患者在住院期间死亡。对术前、术中和术后变量进行单因素检验，随后进行逐步逻辑回归分析，结果确定年龄较大、缺血性心脏病、术后神经系统并发症、心功能不全、肾衰竭和大量出血是与住院死亡率独立相关的因素。10例患者（8.6%）出现神经系统并发症，该并发症的危险因素是术前周围血管疾病。对住院幸存者的随访记录显示，总体累积5年生存率为69%。夹层动脉瘤和真性动脉瘤的5年生存率分别为63%和82%，两者之间无显著差异。在随访期间，18例患者死亡。其中一半病例为血管性死亡，原因包括破裂、猝死和二次手术。单因素分析后进行逐步Cox检验表明，慢性阻塞性肺疾病和术后大量出血史与后期生存率降低有关。我们的经验表明，选择性脑灌注是修复升主动脉和/或主动脉弓疾病的一种安全技术。通过危险因素可识别出这些主动脉疾病的高危亚组患者。对于这些亚组患者，积极且谨慎的管理对于提高早期和晚期生存率是必要的。
