■评价胸主动脉手术中右锁骨下动脉插管的单胸骨入路的结果。
■在2015年1月至2019年12月之间,连续44例患者接受了右锁骨下动脉插管的胸主动脉手术,胸骨切开术后和心包切开术前,通过直接经皮插管,无需额外的锁骨下皮肤切口。手术指征为A型急性主动脉夹层29例(65.9%),11例(25%)近端主动脉瘤,和主动脉弓动脉瘤4(9%)。23例患者的手术是升主动脉置换,Bentall手术10例,半弓置换6例,全弓置换5例。平均体外循环(CPB)和交叉钳夹时间分别为185±62分钟和138±41分钟,分别。
■住院死亡率为6.8%。3例(6.8%)发生永久性神经功能障碍,4例(9.0%)发生暂时性神经功能障碍。没有与此技术相关的血管并发症。没有关于迷走神经和喉返神经病变的报道。
■根据我们的经验,右锁骨下动脉插管的单一胸骨通道可避免腋下动脉插管所需的锁骨下切口的风险和并发症。该技术是安全的,是胸主动脉手术期间CBP和顺行脑灌注的有效选择。
OBJECTIVE: To evaluate outcomes of single sternum access for right subclavian artery cannulation without infraclavicular incision in surgery of the thoracic aorta.
METHODS: Between January 2015 and December 2019, 44 consecutive patients underwent surgery of the thoracic aorta with cannulation of the right subclavian artery, after sternotomy and before pericardiotomy, through a direct percutaneous cannula with a single access without additional infraclavicular skin incision. The indication for surgery was type A acute aortic dissection in 29 patients (65.9%), proximal aortic aneurysm in 11 (25%), and aneurysm of the aortic arch in 4 (9%). Operative procedures were replacement of the ascending aorta in 23 patients, Bentall procedure in 10, hemiarch replacement in 6, and total arch replacement in 5. The mean cardiopulmonary bypass (CPB) and cross-clamp times were 185 ± 62 minutes and 138 ± 41 minutes, respectively.
RESULTS: The in-hospital mortality rate was 6.8%. Permanent neurologic dysfunction occurred in 3 patients (6.8%) and temporary neurologic dysfunction occurred in 4 patients (9.0%). There were no vascular complications related to this technique. No lesions to the vagus and recurrent laryngeal nerves have been reported.
CONCLUSIONS: In our experience, a single sternum access for right subclavian artery cannulation avoids the risk and complications of an infraclavicular incision required for axillary artery cannulation. This technique is safe and represent a valid option for CBP and antegrade cerebral perfusion during surgery of the thoracic aorta.