Retracted: Selective Cerebro‐Myocardial Perfusion Under Mild Hypothermia During Primary Repair for Aortic Coarctation With Ventricular Septal Defect

The following article from Artificial Organs, “Selective Cerebro‐Myocardial Perfusion Under Mild Hypothermia During Primary Repair for Aortic Coarctation With Ventricular Septal Defect” by Huiwen Chen, Haifa Hong, Zhongqun Zhu and Jinfen Liu, published online on 2 November 2012 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor‐in‐Chief, Paul S. Malchesky, the International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. The retraction has been agreed due to simultaneous publication of a substantially similar article, “Continuous Cerebral and Myocardial Perfusion During One‐Stage Repair for Aortic Coarctation With Ventricular Septal Defect”, by Huiwen Chen, Haifa Hong, Zhongqun Zhu and Jinfen Liu, in Pediatric Cardiology 7 November 2012 [Epub ahead of print].     

Successful Resection of Descending Thoracic Aortic Aneurysm Using Hypothermic Total Body Retrograde Perfusion Without Aortic Clamp

A descending thoracic aortic aneurysm was safely resected via a median sternotomy, using total body retrograde perfusion without an aortic clamp. This new technique is an excellent adjunct in surgery for aneurysm of the proximal descending thoracic aorta.     

不同腋动脉插管方法在StanfordA型主动脉夹层手术中的应用

目的比较两种不同右侧腋动脉插管方法对Stanford A型主动脉夹层患者行主动脉弓置换术的安全性和临床效果。方法 2008年7月至2010年7月北京安贞医院对280例Stanford A型主动脉夹层患者采用右侧腋动脉插管建立体外循环(CPB),行全弓置换+降主动脉支架人工血管植入术。根据术中腋动脉插管方式将280例患者分为两组,直接插管组(n=215),年龄(43.1±9.5)岁,行直接腋动脉插管;间接插管组(n=65),年龄(44.7±8.3)岁,腋动脉连接人工血管行间接插管。观察两组患者的安全性,比较相关手术参数、临床结果和术后恢复情况。结果住院死亡10例,其中直接插管组7例(7/215,3.3%),间接插管组3例(3/65,4.6%);所有患者均成功行腋动脉插管;术后25例(25/280,8.9%)出现暂时性神经系统功能障碍,其中直接插管组19例(8.8%),间接插管组6例(9.2%),均经治疗痊愈。间接插管组患者术后腋动脉插管并发症明显少于直接插管组,差异有统计学意义((1例vs.19例,P=0.045)。两组患者体外循环期间最高流量、最高泵压,深低温停循环时间、顺行性脑灌注时间和CPB时间差异均无统计学意义(P0.05)。结论经人工血管右侧腋动脉插管可以降低腋动脉插管相关并发症,安全用于Stanford A型主动脉夹层患者的外科手术治疗。     

Systemic and Cerebral Haemodynamics During Craniotomy Under Mild Hypothermia in Patients with Acute Subarachnoid Haemorrhage

Summary ? Background. Mild hypothermia provides cerebral protection against ischaemic insults in various animal models. We compared systemic and cerebral oxygenation between mild hypothermic and normothermic management in 60 patients with acute subarachnoid haemorrhage who underwent clipping of cerebral aneurysms.  Method. The temperature in the pulmonary artery was maintained at 36°C in 28 patients and was reduced to 34°C in 32 patients. Parameters in the systemic and cerebral haemodynamics from pulmonary artery and internal jugular vein catheters were compared between the two groups immediately after the induction of anaesthesia (T1), and just before temporary occlusion or aneurysm clipping (T2).  Findings. Cardiac index, oxygen delivery index, oxygen consumption index, and oxygen saturation of the jugular bulb were significantly lower at T2 in hypothermic group (H) (2.9±0.6 L/min/m², 400.8±106.3 ml/min·m², 87.0±14.8 ml/min·m², 55.2±6.6%, respectively) than in normothermic group (N) (3.7±0.6, 521.0±105.5, 109.9±21.7, 60.9±6.6) (p<0.05). The arterial lactate and arteriojugular difference in oxygen content were significantly higher in H (2.3±1.3 mmol/L, 6.5±1.5 ml/dl, respectively) than in N (1.7±1.0, 5.6±1.2) (p<0.05). Arteriojugular differences in carbon dioxide tension and hydrogen ion content were significantly lower at T2 in H (−10.8±2.1 mm Hg, −6.4±1.3 nmol/L, respectively) than in N (−8.9±2.8, −5.3±1.0) (p<0.05).  Interpretation. The balance between oxygen supply and demand systemically and in the brain may worsen during aneurysm surgery for patients with acute subarachnoid haemorrhage under mild hypothermia. Oxygenation of the brain and the whole body should be monitored closely during this surgery, and adequate circulatory assistance is recommended under mild hypothermia.     

深低温期间高氧血气管理对停循环兔脑组织的保护作用

目的通过研究深低温期间高氧血气管理对深低温停循环(DHCA)兔血气、生化指标、脑组织中超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量、脑组织含水量的影响,探讨高氧管理的脑保护作用。方法建立兔DHCA+选择性脑灌注(ASCP)动物模型,将24只11～13周龄雄性新西兰兔(体重2.7～3.4 kg)用随机数字表法分为3组:假手术组(Sham组),ASCP组(S组),ASCP+高氧管理组(SH组),每组8只。术中检测动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、颈静脉球血氧分压(PjvO2)、颈静脉球血氧饱和度(SjvO2)和血乳酸(Lac)含量,术后检测脑组织SOD活性、MDA含量和脑组织含水量。结果停循环前、复灌前和复灌5 min SH组PaO2、PjvO2和SjvO2均高于S组和Sham组(P0.05)。SH组脑组织SOD活性与S组[(213.53±33.52)U/mg.prot vs.(193.02±27.67)U/mg.prot]和Sham组[(213.53±33.52)U/mg.prot vs.(244.38±35.02)U/mg.prot]比较差异无统计学意义(P0.05),但S组SOD活性低于Sham组(P0.05)。SH组脑组织MDA含量低于S组[(1.42±0.30)nmol/mg.prot vs.(2.37±0.55)nmol/mg.prot,P0.05]。结论深低温期间的高氧血气管理在DHCA+ASCP中能提供更好的氧供,有效地提高兔PjvO2和SjvO2,维持脑组织SOD活性,降低MDA含量,具有脑保护作用。     

深低温停循环上腔静脉逆行灌注在主动脉瘤手术中的应用

１９９２．９－１９９３．７在深低温停循环连续上腔静脉逆行灌注下行升主动脉瘤及主动脉夹层动脉瘤手术１２例。病变侵及主动脉右弓，主动脉弓或弓降部。包括Ｂｅｎｔａｌｌ手术，高位右弓峡替换１０例；主动脉升，弓，降部替换，头臂动脉移植１例；大动脉炎，升主动脉全长狭窄行长补片成形术１例。病人全部存活。ＤＨＣＡ逆行灌注时间２７－８１ｍｉｎ，病人均于术后４小时内清醒，无神经系统并发症，测定入脑血和出脑血氧含量及乳     

经腋动脉右锁骨下动脉插管和选择性脑灌注技术的应用

目的　介绍经腋动脉右锁骨下动脉插管技术及其体外循环要点。　方法　经腋动脉右锁骨下动脉插管和在深低温停循环下行持续选择性脑灌注技术治疗累及主动脉弓的心血管疾病患者７０ 例。　结果　应用该技术手术治疗累及主动脉弓的心血管疾病７０ 例中,脑部低流量灌注时间最长达８１ 分钟,平均２８ ．０６ ±２１ ．０７ 分钟,术后患者６ 小时内全部清醒,无神经系统并发症。　结论　经腋动脉右锁骨下动脉插管在停循环期间持续选择性脑灌注方法对脑保护简便、安全、有效。     

Application of Aortic Balloon Occlusion in Total Aortic Arch Replacement with Frozen Elephant Trunk on Clinical Endpoints for Aortic Dissection Patients

Purpose: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) is the standard operation for treating aortic dissection (AD) patients involving aortic arch with high operative risk due to long circulatory arrest (CA). We used aortic balloon occlusion technique that safely reduced the CA time to 5 min in average and investigated whether it can improve the clinical endpoints.Methods: All patients diagnosed with AD and underwent TAR with FET operation (123 with aortic balloon occlusion and 221 with conventional method) in Fuwai Hospital during August 2017 and February 2019 was reviewed in this retrospective observational study.Results: After propensity score matching, the 30-day mortality of aortic balloon occlusion group and conventional group was 4.88% and 11.38% (P = 0.062), respectively. In multivariate analysis, aortic balloon occlusion is one of the factors that reduced the risk for renal and hepatic injury, shortened postoperative conscious revival time, and reduced red blood cell (RBC) transfusion during operation.Conclusions: The aortic balloon occlusion technique, as a perfusion strategy during operation, could alleviate postoperative complication. This method deserves further attention in future clinical practice for its value in treating patients with higher operative risks.     

升主动脉和弓部动脉瘤的外科治疗

目的：总结升主动脉和弓部动脉瘤手术治疗经验，以期进一步提高手术疗效。方法：自2000年7月至2002年5月应用深低温停循环（DHCA）和上腔静脉逆行脑灌注（RCP）技术手术治疗升主动脉和弓部动脉瘤20例，其中急症手术5例。施行全弓置换术2例，全弓置换和象鼻手术3例，半弓置换术15例。同期行Bentall手术8例，升主动脉置换术或同时行主动脉瓣置换术12例，冠状动脉旁路移植术1例。结果：术后早期死亡1例，短时间浅昏迷1例，呼吸功能不全2例，肾功能不全2例，无晚期死亡。结论：DHCA和RCP技术是手术治疗升主动脉和弓部瘤的安全、有效方法，急性A型夹层动脉瘤的手术方式取决于内膜破裂口的位置；正确掌握DHCA和RCP技术，手术方式和手术技术、围术期处理是提高手术疗效的关键因素。     

深低温停循环联合顺行性脑灌注对患者认知功能的影响

目的探讨急性StanfordA型主动脉夹层采用深低温停循环联合顺行性脑灌注对患者认知功能的影响。方法2009年1月至2012年3月南京医科大学附属南京医院48例急性StanfordA型主动脉夹层采用孙氏手术（主动脉弓部置换加支架象鼻手术）,其中男40例,女8例,年龄（51．3±13．6）岁。手术均采用深低温停循环、顺行胜脑灌注技术。记录术中停循环时间、术后苏醒时间,根据简易智力状态检查量表（mini．mentalstatesexamination,MMSE）评价患者术前、术后的认知功能。结果48例患者体外循环时间（237．3±58．5）rain,术中停循环时间（37．3±6．9）min。手术死亡4例,死亡原因：肺部感染、多脏器功能衰竭、心肌梗死和急性呼吸窘迫综合征。4l例患者术后24h内苏醒,苏醒时间（1513±6．5）h。MMSE评分术前为（28．6±1．1）分,术后1周时为（23．6±4．5）分。随访3l例,随访率70．45％,随访时间6个月。术后6个月时31例患者MMSE评分为（27．6±2．1）分,较术后MMSE评分大幅度提高（户〈0．05）,但与术前MMSE比较,差异无统计学意义（P〉0．05）。结论治疗急性StanfordA型主动脉夹层采用深低温停循环联合顺行性脑灌注技术,可以取得满意的脑保护效果,但短期内对认知功能可能存在负面影响;只要头颅CT排除梗塞或出血病灶,这种负面影响在半年内基本可以自行消除。     

单侧与双侧顺行性脑灌注对认知能力的影响

目的　比较全主动脉弓置换术中应用单侧顺行性脑灌注和双侧顺行性脑灌注对认知能力的影响。方法　 16例全主动脉弓置换术患者按随机数字表法随机分为单侧顺行性脑灌注组和双侧顺行性脑灌注组 ,每组各 8例。两组均行术前、术后神经系统物理检查、颅脑计算机体层摄影 (CT)和认知能力测验比较。　结果　无手术及近期死亡 ,无新发脑梗塞出现。两组各有 1例出现短暂性神经功能异常 ,两组间术前和术后的认知能力比较差别无统计学意义 (P>0 .0 5 )。　结论　在基底动脉环完整、存在有效侧枝循环的条件下 ,单侧顺行性脑灌注及双侧顺行性脑灌注均能取得良好的效果 ,两种脑保护方法对认知能力的影响无统计学意义。