Baribeau Y R, Westbrook B M, Charlesworth D C, Maloney C T
New England Heart Institute, Catholic Medical Center, Manchester, New Hampshire, USA.
Ann Thorac Surg. 1998 Jul;66(1):33-7. doi: 10.1016/s0003-4975(98)00397-x.
Strategy for severe aortic atheromatous disease identified by intraoperative epiaortic ultrasound remains to be determined. We used axillary artery inflow through graft interposition in an attempt to avoid potential embolization.
Between July 1995 and June 1997, axillary artery inflow was used in 29 patients. Procedures performed were coronary artery bypass in 21 patients (3 with combined carotid endarterectomy), aortic valve replacement in 2, valve replacement plus coronary artery bypass in 4, atrial septal defect repair in 1, and arch replacement in 1 patient. Fibrillatory arrest was used in 16 patients and circulatory arrest was used in 16 patients for excision of mobile atheroma or arch reconstruction. Antegrade cerebral perfusion through the axillary artery graft was carried out in 11 patients.
There were no brachial neurovascular complications. Two operative deaths occurred. Two patients had operative strokes and 2 more had postoperative stroke, all with resolution at late follow-up. There were no strokes in the subset of patients who had antegrade cerebral perfusion during circulatory arrest.
The axillary artery is an excellent site for arterial inflow. Furthermore, antegrade cerebral perfusion is easily accomplished during periods of circulatory arrest. Finally, graft placement avoids potential local neurovascular complications.
术中经主动脉超声识别出的严重主动脉粥样硬化疾病的治疗策略仍有待确定。我们采用经移植血管置入腋动脉进行血流灌注，以试图避免潜在的栓塞。
1995年7月至1997年6月，29例患者采用腋动脉血流灌注。所实施的手术包括：21例患者行冠状动脉旁路移植术（3例合并颈动脉内膜切除术），2例患者行主动脉瓣置换术，4例患者行瓣膜置换加冠状动脉旁路移植术，1例患者行房间隔缺损修补术，1例患者行主动脉弓置换术。16例患者采用心脏颤动停搏，16例患者采用循环停止以切除活动的动脉粥样斑块或进行主动脉弓重建。11例患者经腋动脉移植血管进行顺行性脑灌注。
未发生臂丛神经血管并发症。发生2例手术死亡。2例患者术中发生卒中，另外2例术后发生卒中，所有患者在后期随访时均恢复。在循环停止期间进行顺行性脑灌注的患者亚组中未发生卒中。
腋动脉是动脉血流灌注的理想部位。此外，在循环停止期间很容易实现顺行性脑灌注。最后，移植血管的置入避免了潜在的局部神经血管并发症。
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