Clinical experience of off-pump arch branches preferential reconstruction and whole brain perfusion in the treatment of type A
10.3760/cma.j.cn112434-20210415-00138
- VernacularTitle:A型主动脉夹层全弓替换术采用非体外循环不中断脑供血弓部分支优先重建和全脑灌注的效果
- Author:
Lei CHEN
1
;
Dong LI
;
Yang WU
;
Minghui YAO
;
Jiali WANG
;
Gang WANG
;
Zhiyun GONG
;
Cangsong XIAO
Author Information
1. 中国人民解放军总医院第一医学中心心脏大血管外科，北京 100853
- Keywords:
Off-pump;
Arch branches preferential reconstruction;
Aortic dissection;
Brain protection;
Whole brain perfusion
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2022;38(4):219-222
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To introduce the early results of total aortic arch replacement (TAA) without cardiopulmonary bypass (CPB) and without interruption of cerebral blood supply, using the technique of arch branches preferential reconstruction and whole brain perfusion for brain protection.Methods:Between June 2020 and March 2021, a total of 9 Stanford type A aortic dissection patients we performed total arch replacement by using the technique of arch branches preferential reconstruction and whole brain perfusion without cardiopulmonary bypass and without interruption of blood supply to the brain. The method of this reconstruction technique is as follows: A 24F aortic cannula was inserted into the true lumen at the root of the transverse innominate artery (IA) to connect one end of the artery for cardiopulmonary bypass. The access was connected to 14F artery via Y-connector and inserted into IA cavity to maintain blood supply to brain. Without cardiopulmonary bypass, the 10 mm branch of the four branch artificial blood vessel was anastomosed with the innominate artery IA. The perfusion collateral was connected to the second end of the artery of CPB (single pump and double tubes) to continue to supply blood for IA. The left common carotid artery (LCA) and left subclavian artery (LSCA) were reconstructed by the same method. When IA and LCA were anastomosed, the distal blood supply was not interrupted. After the three branches of the aortic arch were anastomosed, we started to turn the machine, then cooled down and blocked the ascending aorta to further complete the operation of the aortic root and arch. During the period of lower body circulatory arrest, the whole brain was perfused with low flow.Results:No intraoperative death or perioperative complications occurred in all patients, and they were discharged smoothly. The cardiopulmonary bypass time was (192.4±58.1) min, the aortic clamping time was (128.3±52.4) min, the lower body circulatory arrest time was (29.1±1.3) min, and the postoperative awake time was (8.2±3.7) h.Conclusion:Off-pump arch branches preferential reconstruction can provide physiological whole brain perfusion, shorten the cardiopulmonary bypass time and aortic occlusion time, and the operation is safe and effective.
