Nazari S, Salvi S, Aluffi A, Visconti E, Rescigno G, Buniva P
Department of Surgery, University of Pavia, Istituto di Ricovero e Cura a Carattere Scientifico San Matteo, Italy.
Ann Thorac Surg. 1997 Nov;64(5):1339-44. doi: 10.1016/S0003-4975(97)00991-0.
The risk of neurologic complications in aortic arch prosthetic substitution is directly related to the duration of the circulatory arrest. The purpose of this article is to report the experiments on animals of a device for simplifying and quickening the vascular anastomosis in aortic arch substitution.
The device consists of expandable loops of stainless steel wire, sewn to the proximal end of a Dacron prosthesis. An actuating removable guide allows the stainless steel wire loops to be expanded and tightened, in such a way that the prosthesis diameter is varied, while maintaining a regular cylindric shape. The prosthesis end is then transformed into a rigid cylindrical ring, approximately half the maximal diameter in length, with a variable and controllable diameter. A composite graft was prepared, fitted with the expandable device at the distal end of the main prosthesis as well as at each end of the branches for the supraaortic trunks. Cardiopulmonary bypass was established by cannulation of the right atrium and left iliac artery. The prosthesis was positioned very easily and quickly during a brief hypothermic circulatory arrest; ascending aorta anastomosis was carried out by the standard technique after central nervous system reperfusion was resumed. Acute experiments were carried out in 5 swine.
Four of 5 animals survived the procedure without detectable neurologic sequelae. At sacrifice the prosthesis was found to be properly sited without lumen distortion or thrombosis.
The main advantages of this device and modality of arch substitution in a clinical setting would include drastic reduction of the circulatory arrest time, easy and reliable hemostasis of the anastomosis line, and accurate and firm approximation of the dissection layers in case of dissecting aneurysms.
主动脉弓人工血管置换术中神经并发症的风险与循环阻断时间直接相关。本文旨在报告一种用于简化和加速主动脉弓置换术中血管吻合的装置的动物实验。
该装置由可扩张的不锈钢丝环组成，缝在涤纶人工血管的近端。一个可操作的可拆卸导丝使不锈钢丝环能够扩张和收紧，从而改变人工血管的直径，同时保持规则的圆柱形。然后将人工血管末端转变为一个刚性圆柱环，长度约为最大直径的一半，直径可变且可控。制备了一种复合移植物，在主人工血管的远端以及主动脉弓上分支的两端都安装了可扩张装置。通过右心房和左髂动脉插管建立体外循环。在短暂的低温循环阻断期间，人工血管非常容易且快速地就位；在恢复中枢神经系统再灌注后，采用标准技术进行升主动脉吻合。对5头猪进行了急性实验。
5只动物中有4只在手术后存活，没有可检测到的神经后遗症。处死时发现人工血管位置合适，无管腔扭曲或血栓形成。
该装置及主动脉弓置换方式在临床环境中的主要优点包括显著缩短循环阻断时间、吻合口易于可靠止血，以及在夹层动脉瘤情况下准确牢固地贴合解剖层面。
