Zusammenfassung
Wir berichten über 31 Patienten, die im Zeitraum von 11/95 bis 12/96 mittels tiefer Hypothermie, Kreislaufstillstand (HCA) und retrograder Hirnperfusion (RCP) operiert wurden. Die Patienten waren 27 bis 87 (Mittel 61,5) Jahre alt.
Es handelte sich um akute Typ A-Dissektionen (n=22), Bogenaneurysmen (n=5) und andere komplexe Operationen (n=3), die einen längeren Kreislaufstillstand erforderlich machten. Die Kreislaufstillstandszeit betrug zwischen 9 und 71 (Mittel 36,6) Minuten. Die Dauer der retrograden Hirnperfusion lag zwischen 9 und 71 (Mittel 28,7) Minuten.
Von 31 operierten Patienten haben 25 die Operation überlebt (perioperative Mortalität 19,3%). Die Todesursachen waren kardiales Versagen (n=4), Multiorganversagen (n=1) und Hirntod (n=1).
Bei 29 Patienten war postoperativ die neurologische Situation einschätzbar. 21 Patienten waren neurologisch unauffällig und 5 Patienten zeigten ein Durchgangssyndrom. Ein Patient mit einer Hemiparese zeigte diesen Zustand bereits präoperativ. Bei einem Patienten, der komatös zur Aufnahme kam, trat postoperativ der Hirntod ein. Ein Patient war postoperativ paraplegisch.
Wir schlußfolgern, daß die RCP ein wirkungsvolles komplementäres Verfahren zum HCA bei Eingriffen im Bereich der proximalen Aorta und des Aortenbogens ist. Die RCP verlängert die sichere Phase des HCA und führt zu einer Reduktion neurologischer Komplikationen bei derartigen Eingriffen.
Summary
We report on 31 patients who underwent operations under conditions of profound hypothermia, circulatory arrest (HCA) and retrograde cerebral perfusion (RCP) in the period between november 1995 and december 1996.
The patients age ranged between 27 and 87 years, average 61,5 years. The following cases were included: acute type A dissection (n=22), aortic arch aneurysms (n=5) and other complex operations (n=3) necessitating a somewhat longer circulatory arrest period.
The circulation arrest time varied between 9 and 71 (average: 36.6) minutes, with the duration of the ensuing retrograde cerebral perfusion lasting between 9 and 71 (average: 28,7) minutes. Of the 31 patients, 25 survived the operation (perioperative mortality: 19,3%). The causes of death for the remaining 6 were cardiac failure (n=4), multiple organ failure (n=1) and brain-death (n=1).
The neurological status for 29 of these patients was postoperatively assessable. 21 were neurologically unremarkable and 5 patients exhibited transitional psychosis. One hemiparetic patient had shown these symptoms already preoperatively. One patient, who had been delivered in a comatose state, was postoperatively determined to be brain-dead. Finally, one patient was postoperative paraplectic.
We conclude that RCP is an effective complementary procedure to be employed during circulatory arrest in operations involving the proximal aorta and the aortic arch. RCP extends the safe phase of HCA and leads to an additional reduction of neurological complications in such operations.
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Bauer, M., Schaffarczyk, R., Hammerschmidt, R. et al. Zusätzliche Hirnprotektion durch retrograde Hirnperfusion bei Operationen mit tiefer Hypothermie und Kreislaufstillstand. Z. Herz-, Thorax-, Gefäßchir. 11, 277–281 (1997). https://doi.org/10.1007/BF03045203
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DOI: https://doi.org/10.1007/BF03045203