Usefulness of modified perfusion strategy during one-stage repair of aorta coarctation combined with intracardiac malformations
10.3760/cma.j.issn.1001-4497.2014.05.005
- VernacularTitle:改良灌注策略在主动脉缩窄合并心内畸形一期矫治术中的应用
- Author:
Bo KONG
;
Jun YAN
;
Qiang WANG
;
Shoujun LI
;
Jinping LIU
;
Xu WANG
- Publication Type:Journal Article
- Keywords:
Aortic coarctation;
Cerebral perfusion;
Cardiac surgical procedures
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2014;30(5):273-276
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the application and surgical results of the modified perfusion strategy,that means,mild/moderate hypothermia,regional cerebral perfusion combined with cardiac perfusion,in the surgical correction of coarctation of the aorta(CoA) in infants and young children of CoA with intracardiac malformations.Methods From September 2010 to December 2012,59 patients of CoA combined with intracardiac malformation were enrolled in the study,37 males and 22 females..Among them,modifed purfusion strategy were performed in 29 patients,whereas Traditional surgical strategy were applied in 30 randomly selected cases as control.The age of the whole group ranged from 2 to 46 (8.2 ± 6.3) months and the body weight was from 4.0-18 (6.58 ± 2.15) kg.The key points of theModified purfusion strategy include:Cooling to a nasopharyngeal temperature of 26℃-35℃,rectal temperature of 29℃-35℃,Occlusion clamp was placed between the innominate arterv-the left common carotid artery and the distal end of CoA.By keeping the position of asending arotic catheterization unchanged and keeping the heart beating,regional cerebral perfusion combined with heart perfusion were realised at 40-60 ml · kg-1 · min-1 flow rate.With lower body circulatory arrest,CoA were corrected by the approach of end-to-end or extentive end-to-end anastomosis.After the CoA correction is completed,clamping the asending aortic,cardiac arrest,correction of cardiac anomalies.Traditional perfusion strategy group using conventional cardiac arrest,deep hypothermia,regional cerebral perfusion approch to correct COA,the rest of the operation is the same as described above.Results There was no operative death,postoperative pulmonary infection occurred in 12 cases,3 cases occured pneumothorax,1 case suffered wound in fection and underwent secondary debridement,3 cases encountered postoperative oliguria and were treated with peritoneal dialysis.All patients received echocardiography examination before discharge and showed aortic arch coarctation has released,anastomotic stoma is patent,flow rate is normal or slightly fast.All patients were followed up for 3-26 months,no late death or complications occours.Modified perfusion strategy group was significantly superiors to the traditional persufion strategy group in the aspects of cardiac arrest time[(35.3 ± 10.2) min vs.(58.4 ± 19.8) min],auxiliary CPB time [(16.8 ± 4.0) min vs.(31.6 ± 12.1) min] and the vasoactive drug dosage[dopamine:(4.5 ±0.8) μg · kg-1 · min-1 vs.(6.3 ± 1.3) μg · kg-1 · min-1] after surgery.Conclusion Modified perfusion strategy can reduce myocardial injury,significantly reduce cardiac arrset 、circulatory support and temperature adjusting time and shorten the total duration of surgery compared with conventional perfusion strategy,the early result is satisfactory and has broad application prospects.
