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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2003 December;44(6):751-5

lingua: Inglese

Clinical results of aortic arch replacement using a four branched prosthetic graft

Sakamoto S., Matsubara J., Nagayoshi Y., Nishizawa H., Takeuchi K., Nonaka T., Noguchi Y.

Depart­ment of Tho­racic and Car­di­o­vas­cular Sur­gery, Kan­a­zawa Med­ical Uni­vers­ity, Ish­i­kawa, ­Japan

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Aim. The aim of ­this ­study was to eval­uate the oper­a­tive tech­niques of ­total ­arch replace­ment, the clin­ical ­results and the sur­vival ­curves of ­patients fol­lowing ­this pro­ce­dure.
­Methods. ­Since ­December 2001, 92 ­patients ­have under­gone sur­gical treat­ment for ­aortic dis­sec­tion and aneu­rysm. The ­total ­aortic ­arch replace­ment was per­formed in 24 of ­these ­patients. ­There ­were 16 men and 8 ­women, and the age ­range was 42 to 81 ­years ­with a ­mean age of 59.4 ­years. As the oper­a­tive tech­nique for ­total ­arch replace­ment, we ­used the 4-­branched pros­thetic ­graft, selec­tive cere­bral per­fu­sion (SCP), con­tin­uous ­cold ­blood car­di­o­plegia (­CCBC), and ­open ­distal anas­tom­osis ­under cir­cu­la­tory ­arrest. The com­bined oper­a­tions ­were cor­o­nary ­bypass ­grafting in 4 ­patients, ­aortic ­valve sus­pen­sion in 1 ­patient and a Ben­tairs pro­ce­dure in 1 ­patient. ­Eleven (73.3%) ­patients ­with ­acute dis­sec­tion ­required emer­gency oper­a­tion.
­Results. The hos­pital mor­tality ­rate was 25% (6 of the 24 ­patients). The ­causes of ­death ­were mul­tiple ­organ ­failure (MOF) due to ­renal and mes­en­teric ­ischemia in 3 ­patients, cere­bral infarc­tion in 2 ­patients, myo­neph­ro­pathic meta­bolic syn­drome (­MNMS) in 1 ­patient, respec­tively. The ­data con­cerning extra­cor­po­real cir­cu­la­tion was 204±53 ­min in ­total ­pump ­time, 136±43 min in ­aortic ­cross ­clamp ­time, 83±14 min in SCP ­time and 48±10 min in cir­cu­la­tory ­arrest ­time, respec­tively. The ­long-­term ­result in actu­arial sur­vival ­rate was 76% for 5 ­years.
Con­clu­sion. We con­sider the tech­nique of ­total ­arch replace­ment ­using ­4-branched pros­thetic ­graft, SCP, ­CCBC, and ­open ­distal anas­tom­osis is a ­useful oper­a­tive ­method in ­patients ­with ­aortic aneu­rysm.

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