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ENGLISH ABSTRACT
浅低温弓部阻断技术在DeBakey Ⅰ型主动脉夹层修复中的应用
里程楠
贾博
葛翼鹏
钟永亮
于海
杨祎
乔志钰
胡海瓯
刘永民
朱俊明
作者及单位信息
·
DOI： 10.3760/cma.j.cn112434-20240401-00094
Application of mild hypothermia arch-clamping technique for DeBakey Ⅰ aortic dissection
Li Chengnan
Jia Bo
Ge Yipeng
Zhong Yongliang
Yu Hai
Yang Yi
Qiao Zhiyu
Hu Haiou
Liu Yongmin
Zhu Junming
Authors Info & Affiliations
Li Chengnan
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Jia Bo
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Ge Yipeng
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Zhong Yongliang
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Yu Hai
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Yang Yi
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Qiao Zhiyu
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Hu Haiou
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Liu Yongmin
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
Zhu Junming
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
·
DOI： 10.3760/cma.j.cn112434-20240401-00094
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摘要

目的评估浅低温弓部阻断技术在DeBakey Ⅰ型主动脉夹层外科治疗中应用的安全性和有效性。

方法前瞻性纳入北京安贞医院自2019年12月至2023年11月期间行弓部阻断技术治疗的97例DeBakey Ⅰ型主动脉夹层患者。根据停循环期间最低直肠温，分为浅低温组和中低温组，比较两组患者围术期资料，以30天死亡、卒中、截瘫、连续性肾脏替代疗法组成的复合结局事件作为主要终点事件，采用多因素 logistic回归明确临床不良结局的影响因素，采用 Kaplan- Meier法评估两组患者远期生存率，分析浅低温弓部阻断技术在DeBakey Ⅰ型主动脉夹层中的近、远期疗效。

结果整体复合不良结局事件发生率20.6%，浅低温组和中低温组组术后复合不良结局分别为13.6%和22.7%( P＝0.535)，卒中发生率分别为4.6%和6.7%( P＝1.000)，浅低温技术组体外循环和主动脉阻断均显著缩短(147.5 min对163.0 min， P＝0.032；89 min对99 min， P＝0.042)。两组患者远期生存率及再干预率差异无统计学意义(91.9%对89.3%， P＝0.87；9.1%对5.3%， P＝0.13)。

结论浅低温弓部阻断技术取得了满意的近、远期疗效，相较于中低温技术简化了手术流程，可以作为一种安全、有效的DeBakey Ⅰ型主动脉夹层弓部处理方法。

主动脉弓部阻断;DeBakey Ⅰ型主动脉夹层;低温停循环;孙氏手术
ABSTRACT

ObjectiveTo evaluate the safety and efficacy of mild hypothermia arch-clamping technique in the surgical treatment of DeBakey Type Ⅰ aortic dissection.

MethodsFrom December 2019 to November 2023, a total of 97 patients with DeBakey type Ⅰ aortic dissection who underwent arch-clamping technique in Beijing Anzhen Hospital were prospectively enrolled. The patients were divided into mild hypothermia group and moderate hypothermia group according to the lowest rectal temperature during the circulatory arrest period. The perioperative data of the two groups were compared, and complex adverse outcomes consisting of 30-day death, stroke, paraplegia and CRRT were used as the primary endpoint. Multivariate logistic regression was used to determine the predictors of clinical adverse outcomes. Survival analysis was evaluated by the Kaplan- Meier method.

ResultsThe overall incidence of complex adverse outcomes was 20.6%, 13.6% in the mild hypothermia group and 22.7% in the moderate hypothermia group( P=0.535), and the incidence of stroke was 4.6% and 6.7%( P=1.000), respectively. The cardiopulmonary bypass time and aortic-clamping time in the mild hypothermia group were significantly shortened (147.5 min vs. 163.0 min, P=0.032; 89 min vs. 99 min, P=0.042). There was no significant difference in long-term survival and reintervention between the two groups(91.9% vs. 89.3%, P=0.87; 9.1% vs. 5.3%, P=0.13).

ConclusionMild hypothermia arch-clamping technique is a safe and effective method for the treatment of DeBakey type Ⅰ aortic dissection, with satisfactory short-term and long-term efficacy.

Arch-clamping;DeBakey Type Ⅰ aortic dissection;Hypothermic circulatory arrest;Sun’s procedure
Zhu Junming Email: mocdef.3ab61mjznehzna
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引用本文

里程楠,贾博,葛翼鹏,等. 浅低温弓部阻断技术在DeBakey Ⅰ型主动脉夹层修复中的应用[J]. 中华胸心血管外科杂志,2025,41(03)：136-142.

DOI:10.3760/cma.j.cn112434-20240401-00094

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急性A型主动脉夹层(acute type A aortic dissection，ATAAD)是一种心血管危重症，需要急诊外科手术以挽救患者生命。DeBakey Ⅰ型主动脉夹层是指夹层病变由升主动脉累及主动脉弓或弓部以远降主动脉等，该类病变较DeBakey Ⅱ型主动脉夹层病变范围更广，目前研究表明，全主动脉弓替换加支架象鼻置入术即孙氏手术是该类病变的经典手术方案，并已被证实可以显著改善患者临床预后并显著降低主动脉远期再手术发生率 [ 1 , 2 , 3 ]。然而，孙氏手术需要应用低温停循环和选择性脑灌注技术辅助，不可避免地存在脏器缺血再灌注损伤的风险，因而脏器保护成为了当下研究热点 [ 4 ]。本团队前期以如何缩短停循环时间为切入点，将孙氏手术进一步优化，在中低温停循环技术辅助下，采用主动脉弓部阻断技术，将阻断钳阻断于左颈总与左锁骨下动脉之间，通过股动脉插管灌注，成功将孙氏手术停循环时间由既往20 min缩短至3 min左右，显著改善了ATAAD患者临床预后 [ 5 , 6 , 7 ]。
本中心在前期研究基础上，将停循环温度提升至浅低温技术辅助，进一步优化了弓部阻断技术方案，目前取得了满意的临床疗效。本研究通过对浅低温组与中低温组患者临床预后的比较，明确浅低温弓部阻断技术安全性和有效性，报道如下。
参考文献
[1]
Czerny M , Grabenwöger M , Berger T ,et al. EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ[J]. Ann Thorac Surg, 2024，118(1)：5-115. doi： 10.1016/j.athoracsur.2024.01.021 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Sun L , QI R , Zhu J . Total arch replacement combined with stented elephant trunk implantation: a new " standard " therapy for type a dissection involving repair of the aortic arch？ [J]. Circulation, 2011,123(9):971-978. doi： 10.1161/circulationaha.110.015081 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Ma WG , Zheng J , Dong SB ,et al. Sun ' s procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection [J]. Ann Cardiothorac Surg, 2013,2(5):621-628. doi： 10.3978/j.issn.2225-319X.2013.09.06 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Yoo JS , Kim JB , Joo Y ,et al. Deep hypothermic circulatory arrest versus non-deep hypothermic beating heart strategy in descending thoracic or thoracoabdominal aortic surgery[J]. Eur J Cardiothorac Surg, 2014,46(4):678-684. doi： 10.1093/ejcts/ezu053 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Luo C , Jia B , Li C ,et al. Perfusion management of arch-clamping technique in total arch replacement with frozen elephant trunk[J]. Perfusion, 2024,39(1):182-188. doi： 10.1177/02676591221134221 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
肖付诚，葛翼鹏，里程楠，等．弓部阻断技术治疗急性A型主动脉夹层[J]. 中华胸心血管外科杂志， 2022,38(4)：215-218. doi： 10.3760/cma.j.cn112434-20210524-00178 .
返回引文位置Google Scholar
百度学术
万方数据
Xiao FC , Ge YP , Li CN ，et al. Arch-clamping technique for surgical repair of acute type A aortic dissection[J]. Chin J Thorac Cardiovasc Surg, 2022,38(4):215-218. doi： 10.3760/cma.j.cn112434-20210524-00178 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[7]
罗程，贾博，钟永亮，等. 新型弓部阻断孙氏手术治疗急性Stanford A型主动脉夹层—单中心67例早期临床结果分析[J]. 中华胸心血管外科杂志， 2023，39(9)：564-567. doi： 10.3760/cma.j.cn112434-20220825-00280 .
返回引文位置Google Scholar
百度学术
万方数据
Luo C , Jia B , Zhong YL ,et al. New aortic arch-clamping technique in Sun ' s procedure to repair acute type A aortic dissection: an early clinical analysis of 67 cases in a single center [J]. Chin J Thorac Cardiovasc Surg, 2023，39(9)：564-567. doi： 10.3760/cma.j.cn112434-20220825-00280 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[8]
Eckardt KU , Kasiske BL . Kidney disease: improving global outcomes[J]. Nat Rev Nephrol, 2009,5(11):650-657. doi： 10.1038/nrneph.2009.153 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Yan TD , Tian DH , Lwmaire SA ,et al. Standardizing clinical end points in aortic arch surgery: a consensus statement from the International Aortic Arch Surgery Study Group[J]. Circulation, 2014,129(15):1610-1616. doi： 10.1161/circulationaha.113.006421 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Zindovic I , Gudbjartsson T , Ahlsson A ,et al. Malperfusion in acute type A aortic dissection: an update from the nordic consortium for acute type A aortic dissection[J]. J Thorac Cardiovasc Surg, 2019,157(4):1324-1333.e6. doi： 10.1016/j.jtcvs.2018.10.134 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Griepp RB , Stinson EB , Hollingsworth JF ,et al. Prosthetic replacement of the aortic arch[J]. J Thorac Cardiovasc Surg, 1975,70(6):1051-1063.
返回引文位置Google Scholar
百度学术
万方数据
[12]
Dieusanio M , Wesselink RM , Morshuis WJ ,et al. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: a retrospective comparative study[J]. J Thorac Cardiovasc Surg, 2003,125(4):849-854. doi： 10.1067/mtc.2003.8 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Algarni KD , Yanagawa B , Rao V ,et al. Profound hypothermia compared with moderate hypothermia in repair of acute type A aortic dissection[J]. J Thorac Cardiovasc Surg, 2014,148(6):2888-2894. doi： 10.1016/j.jtcvs.2014.01.020 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Wu J , Qiu J , Fang Z ,et al. Optimal degree of hypothermia in total arch replacement for type A aortic dissection [J]. Front Cardiovasc Med, 2021,8:668333. doi： 10.3389/fcvm.2021.668333 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Pupovac SS , Hemli JM , Bavaria JE ,et al. Moderate versus deep hypothermia in type A acute aortic dissection repair: insights from the international registry of acute aortic dissection[J]. Ann Thorac Surg, 2021,112(6):1893-1899. doi： 10.1016/j.athoracsur.2021.01.027 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Pupovac SS , Hemli JM , GiammarinoI AT ,et al. Deep versus moderate hypothermia in acute type A aortic dissection: a propensity-matched analysis[J]. Heart Lung Circ, 2022,31(12):1699-1705. doi： 10.1016/j.hlc.2022.07.021 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Wang X , Liu N , Wang H ,et al. Femoral artery cannulation increases the risk of postoperative stroke in patients with acute DeBakey I aortic dissection[J]. J Thorac Cardiovasc Surg, 2023,166(4):1023-1031.e15. doi： 10.1016/j.jtcvs.2021.12.049 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Strauch JT , Spielvogel D , Haldenwang PL ,et al. Impact of hypothermic selective cerebral perfusion compared with hypothermic cardiopulmonary bypass on cerebral hemodynamics and metabolism[J]. Eur J Cardiothorac Surg, 2003,24(5):807-816. doi： 10.1016/s1010-7940(03)00517-7 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Zierer A , El-sayed Ahmad A , Papadopoulos N ,et al. Fifteen years of surgery for acute type A aortic dissection in moderate-to-mild systemic hypothermia？[J]. Eur J Cardiothorac Surg, 2017,51(1):97-103. doi： 10.1093/ejcts/ezw289 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Liu Y , Shi Y , Guo H ,et al. Aortic balloon occlusion technique versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion in total arch replacement and frozen elephant trunk for acute type A aortic dissection[J]. J Thorac Cardiovasc Surg, 2021,161(1):25-33. doi： 10.1016/j.jtcvs.2019.08.074 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Jassar AS , Vallabhajosyula P , Bavaria JE ,et al. Direct innominate artery cannulation: an alternate technique for antegrade cerebral perfusion during aortic hemiarch reconstruction[J]. J Thorac Cardiovasc Surg, 2016,151(4):1073-1078. doi： 10.1016/j.jtcvs.2015.11.027 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Zierer A , Detho F , Dzemali O ,et al. Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients[J]. Ann Thorac Surg, 2011,91(6):1868-1673. doi： 10.1016/j.athoracsur.2011.02.077 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Comas GM , Leshnower BG , Halkos ME ,et al. Acute type a dissection: impact of antegrade cerebral perfusion under moderate hypothermia[J]. Ann Thorac Surg, 2013,96(6):2135-2141. doi： 10.1016/j.athoracsur.2013.06.085 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Leshnower BG , Thourani VH , Halkos ME ,et al. Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type A dissection[J]. Ann Thorac Surg, 2015,100(5):1563-1568;discussion 1568-1569.doi： 10.1016/j.athoracsur.2015.05.032 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Livesay JJ , Cooley DA , Reul GJ ,et al. Resection of aortic arch aneurysms: a comparison of hypothermic techniques in 60 patients[J]. Ann Thorac Surg, 1983,36(1):19-28. doi： 10.1016/s0003-4975(10)60643-1 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Kamiya H , Hagl C , Kropivnitskaya I ,et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis[J]. J Thorac Cardiovasc Surg, 2007,133(2):501-509. doi： 10.1016/j.jtcvs.2006.09.045 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Zhang CH , Ge YP , Zhong YL ,et al. Massive bleeding after surgical repair in acute type A aortic dissection patients: risk factors, outcomes, and the predicting model[J]. Front Cardiovasc Med, 2022,9:892696. doi： 10.3389/fcvm.2022.892696 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Jiang S , Li Y , Li C ,et al. The association of coagulation indicators with in-hospital acute kidney injury and malignant events of patients with acute aortic dissection: a retrospective cohort study[J]. J Thorac Dis, 2023,15(2):658-667. doi： 10.21037/jtd-23-38 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Internationa EM . Retracted: clinical factors of blood transfusion-related acute lung injury and changes in leve ls of treg-related cytokines [J]. Emerg Med Int, 2024,2024:9796183. doi： 10.1155/2024/9796183 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
朱俊明　Email: mocdef.3ab61mjznehzna
B

里程楠：技术开展、论文修改、研究实施；贾博：研究设计、研究实施、统计学分析、论文撰写；葛翼鹏：研究设计、研究实施；钟永亮：研究指导；于海、杨祎：数据整理；乔志钰、胡海瓯、刘永民：技术指导；朱俊明：研究设计、论文修改、研究指导、行政及经费支持

C
所有作者均声明不存在利益冲突
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北京市科技计划项目 (Z221100007422112)
北京市科技计划项目 (Z191100006619093)
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