Assessment of supra-arch branches bypass on cerebral oxygen saturation and carotid hemodynamics in patients with Stanford type B aortic dissection
10.3760/cma.j.cn112434-20200904-00407
- VernacularTitle:弓上分流术对Stanford B型主动脉夹层患者脑氧饱和度及颈动脉血流动力学影响的分析
- Author:
Fei XIAO
1
;
Jue YANG
;
Tucheng SUN
;
Changjiang YU
;
Xiaoping FAN
;
Jianfang LUO
;
Yuan LIU
;
Wenhui HUANG
;
Hongwen FEI
;
Ruixin FAN
Author Information
1. 广东省人民医院（广东省医学科学院） 广东省心血管病研究所心外科 华南结构性心脏病重点实验室，广州 510080
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2020;36(10):608-612
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effects of supra-arch branches bypass on cerebral oxygen saturation and hemodynamics in patients with Stanford type B aortic dissection.Methods:From January to December 2018, consecutive 27 patients with Stanford type B aortic dissection were enrolled in the study. All patients received hybrid treatment, including supra-arch branches bypass(right axillary artery-left common carotid artery-left subclavian artery) and thoracic endovascular aortic repaire(TEVAR). All the operations were performed by the same surgical team. The left and right cerebral oxygen saturation were measured after anesthesia(T1), left carotid artery occlusion(T2) and after operation(T3); peak systolic velocity(PSV) and resistance index(RI) of left and right carotid arteries were measured before(t1) and after operation(t2).Results:The left cerebral oxygen saturation was 0.62 ±0.01, 0.54±0.01 and 0.62±0.01 at T1, T2 and T3, respectively. There was significant difference between T2 and T1 and T3( P=0.002, P=0.001), but there was no significant difference between T1 and T3. The PSV of left carotid artery at t1 and t2 were(0.91±0.11)m/s and(0.76±0.09)m/s respectively, with no significant difference( P= 0.191). The RI of left carotid artery at t1 and t2 were 0.83±0.06 and 0.93±0.13 respectively, with no significant difference( P= 0.575). Conclusion:If one side of carotid artery was blocked for a short time during supra-arch branches bypass, the cerebral oxygen saturation would be decreased temporarily, but the changes of cerebral oxygen metabolism could be completely restored after operation. However, the hemodynamics of carotid artery would not change significantly. In the hybrid treatment strategy for the patients with aortic dissection Stanford type B, blocking bilateral carotid arteries can be avoided. Making the right axillary artery-left common carotid artery-left subclavian artery shunt is a safe and effective choice.
