Objectives: Thoracoabdominal aortic aneurysm (TAAA) prosthetic vessel replacement is one of the most complex operations in the field of cardiovascular surgery. The key to success of this operation is to prevent and avoid ischemia of important organs while repairing TAAA. This study aims to summarize and analyze the effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA.
Methods: Data of 15 patients with TAAA who underwent prosthetic vessel replacement under left heart bypass in Xiangya Hospital of Central South University were retrospectively analyzed. According to Crawford classification, there were 2 cases of type I, 8 cases of type II, 3 cases of type III, and 2 cases of type V. There were 14 cases of selective operation and 1 case of emergency operation. All operations were performed under left heart bypass, and cerebrospinal fluid drainage was performed before operation. Left heart bypass was established by intubation of left inferior pulmonary vein and distal abdominal aorta or left femoral artery. The thoracoabdominal aorta was replaced segment by segment. After aortic dissection, the kidneys were perfused with cold crystalloid renal protective solution, and the celiac trunk and superior mesenteric artery were perfused with warm blood.
Results: One patient with TAAA after aortic dissection of type A died. During the operation, straight blood vessels were used to repair TAAA, and the celiac artery branches were trimmed into island shape and anastomosed with prosthetic vessels. After the operation, massive bleeding occurred at the anastomotic stoma, then anaphylactic reaction occurred during massive blood transfusion, resulting in death. One patient suffered from paraplegia due to ischemic injury of spinal cord. The other patients recovered well and were discharged. The postoperative ventilation time was (16.5±13.8) h and the postoperative hospital stay was (10±4) d. The amount of red blood cell transfusion was (13±9) U. The patients were followed up for 2 months to 2 years, and the recovery was satisfactory.
Conclusions: The effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA is good, which is worthy of clinical promotion.
目的: 胸腹主动脉瘤人工血管置换术是目前心血管外科领域最复杂的手术之一。在修复胸腹主动脉瘤的同时预防和避免重要脏器缺血是该手术成功的关键。本研究总结并分析左心转流下人工血管置换术治疗胸腹主动脉瘤的效果。方法: 回顾性分析在中南大学湘雅医院行左心转流下人工血管置换术的15例胸腹主动脉瘤患者的手术资料。Crawford分型I型2例，II型8例，III型3例，V型2例。择期手术14例，急诊手术1例。手术均在左心转流下完成，术前常规进行脑脊液引流。通过左下肺静脉插管及腹主动脉远端或左侧股动脉插管，建立左心转流通路。分段阻断主动脉后逐段置换胸腹主动脉。切开腹主动脉后，采用冷晶体肾保护液灌注双肾，持续温血灌注腹腔干和肠系膜上动脉。结果: 死亡1例，为主动脉A型夹层术后胸腹主动脉瘤患者，术中采用直血管修补胸腹主动脉瘤，将腹腔动脉分支修剪成岛状后与人工血管吻合；术后吻合口发生大出血，在大量输血过程中发生过敏反应导致死亡。1例患者因脊髓缺血性损伤导致截瘫。其他患者术后恢复良好，均痊愈出院。术后呼吸机辅助时间为(16.5±13.8) h，术后住院时间为(10±4) d，术后红细胞输注量为(13±9) U。术后随访2个月至2年，患者恢复满意。结论: 左心转流下人工血管置换术治疗胸腹主动脉瘤效果好，值得在临床推广。.
Keywords: left heart bypass; prognosis; prosthetic vessel replacement; thoracoabdominal aortic aneurysm.