停循环技术应用于升主动脉-胸降主动脉人工血管旁路移植治疗主动脉缩窄_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

刘兴荣 , 马国涛 , 刘剑州 , 张超纪 ,  苗齐 , 李晓凤 , 曹丽华

中国医学科学院北京协和医院心外科（北京 100730）;

Corresponding author：

苗齐, Email: miaoqipumc@hotmail.com

Keywords：

主动脉缩窄; 人工血管; 旁路移植; 深低温停循环

DOI：

10.7507/1007-4848.201808042

Video：

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目的总结经单一胸部正中切口采用低温停循环技术行解剖外升主动脉-胸降主动脉人工血管旁路移植术治疗主动脉缩窄的经验。方法回顾性分析 2009 年 12 月至 2018 年 5 月我院连续 12 例主动脉缩窄患者的临床资料。其中男女各 6 例，年龄 13～42 岁，均有高血压症状，上下肢动脉收缩压差 46～85（57.1±16.8）mm Hg。手术经胸部正中切口，采用体外循环及深低温停循环技术，行升主动脉-心包后胸降主动脉人工血管旁路移植术。结果人工血管平均直径 14～20（17.2±1.8）mm，体外循环时间 69～197（115.9±40.6）min，主动脉阻断时间 41～142（69.8±30.7）min，深低温停循环时间 9～27（16.8±4.1）min。所有患者均未输血，无严重并发症。术后上下肢动脉收缩压差值为 –12～22（14.3±4.8）mm Hg，较术前显著下降（P<0.01）。所有患者均康复出院，平均随访 3～91（41.9±21.5）个月，随访期间仅 1 例患者术后需要服用 1 种降压药物，其余患者均正常。结论深低温停循环下经胸部切口行解剖外人工血管旁路移植术治疗主动脉缩窄安全有效，未来需要更多病例进一步验证。

Citation： 刘兴荣, 马国涛, 刘剑州, 张超纪, 苗齐, 李晓凤, 曹丽华. 停循环技术应用于升主动脉-胸降主动脉人工血管旁路移植治疗主动脉缩窄. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(6): 611-614. doi: 10.7507/1007-4848.201808042 Copy

1.	Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
2.	杨思源, 陈树宝, 主编. 小儿心脏病学(第 4 版). 北京: 人民卫生出版社, 2012. 384.
3.	Campbell M. Natural history of coarctation of the aorta. Br Heart J, 1970, 32(5): 633-640.
4.	Tulzer A, Mair R, Kreuzer M, et al. Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg, 2016, 152(6): 1506-1513.
5.	罗国华, 闫军, 王强, 等. 婴儿期主动脉缩窄的外科治疗. 实用临床医药杂志, 2010, 14(15): 48-49.
6.	陈斌, 安永. 婴幼儿主动脉缩窄外科治疗研究进展. 现代医药卫生, 2014, 30(13): 1971-1973.
7.	Torok RD, Campbell MJ, Fleming GA, et al. Coarctation of the aorta: Management from infancy to adulthood. World J Cardiol, 2015, 7(11): 765-775.
8.	Cardoso G, Abecasis M, Anjos R, et al. Aortic coarctation repair in the adult. J Card Surg, 2014, 29(4): 512-518.
9.	潘旭东, 郑斯宏, 葛翼鹏, 等. 心外旁路人工血管转流术矫治成人复杂主动脉缩窄. 中华外科杂志, 2012, 50(2): 124-127.
10.	Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg, 1945, 14: 347-361.
11.	Piciucchi S, Goodman LR, Earing M, et al. Aortic aneurysms: delayed complications of coarctation of the aorta repair using Dacron patch aortoplasty. J Thorac Imaging, 2008, 23(4): 278-283.
12.	Nakamura E, Nakamura K, Furukawa K, et al. Selection of a surgical treatment approach for aortic coarctation in adolescents and adults. Ann Thorac Cardiovasc Surg, 2018, 24(2): 97-102.
13.	Obata S, Mukai S, Morimoto H, et al. Successful ascending aorta-abdominal aorta bypass graft through the left thoracic cavity in a patient with atypical coarctation. Ann Vasc Dis, 2013, 6(3): 670-673.
14.	Tabry IF, Zachariah ZP. Right thoracotomy approach for repair of recurrent or complex coarctation of the aorta using an extra-anatomic ascending aorta to descending aorta bypass graft off-pump. Multimed Man Cardiothorac Surg, 2013, 2013: mms021.
15.	Arakelyan V, Spiridonov A, Bockeria L. Ascending-to-descending aortic bypass via right thoracotomy for complex (re-) coarctation and hypoplastic aortic arch. Eur J Cardiothorac Surg, 2005, 27(5): 815-820.
16.	Vijayanagar R, Natarajan P, Eckstein PF, et al. Aortic valvular insufficiency and postductal aortic coarctation in the adult. Combined surgical management through median sternotomy: a new surgical approach. J Thorac Cardiovasc Surg, 1980, 79(2): 266-268.
17.	Izhar U, Schaff HV, Mullany CJ, et al. Posterior pericardial approach for ascending aorta-to-descending aorta bypass through a median sternotomy. Ann Thorac Surg, 2000, 70(1): 31-37.
18.	Almeida de Oliveira S, Lisboa LA, Dallan LA, et al. Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy: midterm clinical and magnetic resonance imaging results. Ann Thorac Surg, 2003, 76(6): 1962-1966.
19.	Vergales JE, Gangemi JJ, Rhueban KS, et al. Coarctation of the aorta - the current state of surgical and transcatheter therapies. Curr Cardiol Rev, 2013, 9(3): 211-219.
20.	Tretter JT, Jones TK, McElhinney DB. Aortic wall injury related to endovascular therapy for aortic coarctation. Circ Cardiovasc Interv, 2015, 8(9): e002840.
21.	Hu ZP, Wang ZW, Dai XF, et al. Outcomes of surgical versus balloon angioplasty treatment for native coarctation of the aorta: a meta-analysis. Ann Vasc Surg, 2014, 28(2): 394-403.
22.	Yeaw X, Murdoch DJ, Wijesekera V, et al. Comparison of surgical repair and percutaneous stent implantation for native coarctation of the aorta in patients ≥ 15 years of age. Int J Cardiol, 2016, 203: 629-631.

1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
2. 杨思源, 陈树宝, 主编. 小儿心脏病学(第 4 版). 北京: 人民卫生出版社, 2012. 384.
3. Campbell M. Natural history of coarctation of the aorta. Br Heart J, 1970, 32(5): 633-640.
4. Tulzer A, Mair R, Kreuzer M, et al. Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg, 2016, 152(6): 1506-1513.
5. 罗国华, 闫军, 王强, 等. 婴儿期主动脉缩窄的外科治疗. 实用临床医药杂志, 2010, 14(15): 48-49.
6. 陈斌, 安永. 婴幼儿主动脉缩窄外科治疗研究进展. 现代医药卫生, 2014, 30(13): 1971-1973.
7. Torok RD, Campbell MJ, Fleming GA, et al. Coarctation of the aorta: Management from infancy to adulthood. World J Cardiol, 2015, 7(11): 765-775.
8. Cardoso G, Abecasis M, Anjos R, et al. Aortic coarctation repair in the adult. J Card Surg, 2014, 29(4): 512-518.
9. 潘旭东, 郑斯宏, 葛翼鹏, 等. 心外旁路人工血管转流术矫治成人复杂主动脉缩窄. 中华外科杂志, 2012, 50(2): 124-127.
10. Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg, 1945, 14: 347-361.
11. Piciucchi S, Goodman LR, Earing M, et al. Aortic aneurysms: delayed complications of coarctation of the aorta repair using Dacron patch aortoplasty. J Thorac Imaging, 2008, 23(4): 278-283.
12. Nakamura E, Nakamura K, Furukawa K, et al. Selection of a surgical treatment approach for aortic coarctation in adolescents and adults. Ann Thorac Cardiovasc Surg, 2018, 24(2): 97-102.
13. Obata S, Mukai S, Morimoto H, et al. Successful ascending aorta-abdominal aorta bypass graft through the left thoracic cavity in a patient with atypical coarctation. Ann Vasc Dis, 2013, 6(3): 670-673.
14. Tabry IF, Zachariah ZP. Right thoracotomy approach for repair of recurrent or complex coarctation of the aorta using an extra-anatomic ascending aorta to descending aorta bypass graft off-pump. Multimed Man Cardiothorac Surg, 2013, 2013: mms021.
15. Arakelyan V, Spiridonov A, Bockeria L. Ascending-to-descending aortic bypass via right thoracotomy for complex (re-) coarctation and hypoplastic aortic arch. Eur J Cardiothorac Surg, 2005, 27(5): 815-820.
16. Vijayanagar R, Natarajan P, Eckstein PF, et al. Aortic valvular insufficiency and postductal aortic coarctation in the adult. Combined surgical management through median sternotomy: a new surgical approach. J Thorac Cardiovasc Surg, 1980, 79(2): 266-268.
17. Izhar U, Schaff HV, Mullany CJ, et al. Posterior pericardial approach for ascending aorta-to-descending aorta bypass through a median sternotomy. Ann Thorac Surg, 2000, 70(1): 31-37.
18. Almeida de Oliveira S, Lisboa LA, Dallan LA, et al. Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy: midterm clinical and magnetic resonance imaging results. Ann Thorac Surg, 2003, 76(6): 1962-1966.
19. Vergales JE, Gangemi JJ, Rhueban KS, et al. Coarctation of the aorta - the current state of surgical and transcatheter therapies. Curr Cardiol Rev, 2013, 9(3): 211-219.
20. Tretter JT, Jones TK, McElhinney DB. Aortic wall injury related to endovascular therapy for aortic coarctation. Circ Cardiovasc Interv, 2015, 8(9): e002840.
21. Hu ZP, Wang ZW, Dai XF, et al. Outcomes of surgical versus balloon angioplasty treatment for native coarctation of the aorta: a meta-analysis. Ann Vasc Surg, 2014, 28(2): 394-403.
22. Yeaw X, Murdoch DJ, Wijesekera V, et al. Comparison of surgical repair and percutaneous stent implantation for native coarctation of the aorta in patients ≥ 15 years of age. Int J Cardiol, 2016, 203: 629-631.

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停循环技术应用于升主动脉-胸降主动脉人工血管旁路移植治疗主动脉缩窄

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