PDF(Pubmed)
Abstract：
(1) Background: Conventional open surgery is still the gold standard for aortic arch disease, and despite recent developments in optimizing strategies for neuroprotection, distal organ perfusion, and myocardial protection, aortic arch replacement is still associated with high morbidity and mortality rates. (2) Methods: We present our case series of 12 patients undergoing surgical management of multiple cardiac diseases involving the aortic arch. In this single-center study, we report our initial experience over a five-year period (from December 2018 to October 2023) with the use of a \"debranching first\" technique for the supra-aortic vessels of a beating heart, followed by the cardiac step addressing proximal diseases, and a final distal step treating the aortic arch. This strategy aims to minimize cardiac, cerebral, and peripheral ischemia. (3) Results: Six patients underwent aortic root replacement with either Bentall (n = 4) or valve-sparing aortic root (David procedure) (n = 2). The mean nasopharyngeal temperature was 34 °C and the mean cardiocirculatory arrest was 14.3 min. The early mortality was 8.3% (1 patient); no patient experienced a permanent neurologic event. (4) Conclusions: In patients with complex aortic disease and concomitant cardiac disease, this approach reduces the need for hypothermia and decreases cardiopulmonary bypass time and myocardial arrest time and therefore could represent a valid surgical option, even in high-risk patients.
摘要：
(1)背景:常规开腹手术仍是主动脉弓疾病的金标准,尽管最近在优化神经保护策略方面取得了进展，远端器官灌注，和心肌保护，主动脉弓置换术仍然具有较高的发病率和死亡率。（2）方法：我们介绍了我们的病例系列，其中12例患者接受了累及主动脉弓的多种心脏疾病的手术治疗。在这项单中心研究中，我们报告了我们在五年期间（从2018年12月到2023年10月）使用“先脱支”技术治疗心脏跳动的主动脉上血管的初步经验，接着是解决近端疾病的心脏步骤，和治疗主动脉弓的最后一个远端步骤。该策略旨在最大程度地减少心脏，大脑，和外周缺血。（3）结果：6例患者接受了Bentall（n=4）或保留瓣膜的主动脉根（David程序）（n=2）的主动脉根置换。平均鼻咽温度为34°C，平均心脏循环停止为14.3分钟。早期死亡率为8.3%（1例）；没有患者经历永久性神经系统事件。(4)结论:复杂主动脉疾病合并心脏病患者,这种方法减少了对低温的需要，减少了心肺转流时间和心肌骤停时间，因此可以代表一种有效的手术选择。即使是高危患者。
