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Zerebrale Protektion während offen-chirurgischer Rekonstruktionen des Aortenbogens

Cerebral protection during open surgical reconstruction of the aortic arch

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Zusammenfassung

Die chirurgische Behandlung thorakaler Aortenaneurysmen und -dissektionen, die den Aortenbogen mit einbeziehen, sind nach wie vor eine Herausforderungen in der Gefäßchirurgie. Vor allem der Schutz des Gehirns und des Rückenmarks vor ischämischen und embolischen Komplikationen, die Vermeidung von Gerinnungsstörungen und Blutungen sowie die Prävention einer myokardialen Schädigung während der extrakorporalen Zirkulation gehören zu den primären chirurgischen Zielen.

Verschiedene Techniken wie die tiefe Hypothermie mit Kreislaufstillstand, die retrograde zerebrale Perfusion über die V. cava superior wie auch die selektive antegrade Gehirnperfusion sind in den klinischen Alltag eingeführt worden, um das zentrale Nervensystem vor ischämischen Schäden während der Dauer der Aortenbogenrekonstruktion zu schützen. Trotz aller Vorzüge der protektiven Methoden kommt es jedoch noch relativ häufig zu ischämischen Gehirnkomplikationen. Die Kenntnisse über die Vor- und Nachteile der drei Techniken sowie über die pathophysiologischen Konsequenzen der tiefen Hypothermie sollten bei der Entscheidung über die Indikation eines Kreislaufstillstands wie auch dessen Dauer mitwirken.

Abstract

The surgical treatment of thoracic aorta aneurysms and dissections which include the aortic arch, are still a great challenge in vascular surgery. The primary aims of surgery are protection of the brain and the spinal column from ischemic and embolic complications, avoidance of coagulation disorders and hemorrhaging as well as the prevention of myocardial damage during extracorporeal circulation.

Various techniques have been included in the clinical routine in order to protect the central nervous system from ischemic damage during aortic arch reconstruction. These include deep hypothermia with circulation arrest, retrograde cerebral perfusion via the superior vena cava as well as selective antegrade cerebral perfusion. Despite all advantages of these protective methods ischemic cerebral complications are still relatively common. Knowledge on the advantages and disadvantages of the three techniques as well as the pathophysiological consequences of deep hypothermia should be included in decision making on the indications for circulation arrest and the duration.

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Authors and Affiliations

  1. European Vascular Center Aachen-Maastricht, Kliniken für Gefäßchirurgie, Universitätsklinika Aachen und Maastricht, Deutschland und Niederlande, Pauwelsstr. 30, 52074, Aachen, Deutschland

    G. Mommertz, S. Langer, T.A. Koeppel, G.W.H. Schurink &  M. Jacobs

  2. Klinik für Neurophysiology, Universitätsklinikum Maastricht, Niederlande, Maastricht, Niederlande

    W.H. Mess

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  1. G. Mommertz
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  2. S. Langer
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  3. T.A. Koeppel
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  4. G.W.H. Schurink
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  5. W.H. Mess
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  6. M. Jacobs
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Correspondence to M. Jacobs.

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Mommertz, G., Langer, S., Koeppel, T. et al. Zerebrale Protektion während offen-chirurgischer Rekonstruktionen des Aortenbogens. Gefässchirurgie 14, 92–99 (2009). https://doi.org/10.1007/s00772-008-0663-z

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  • DOI: https://doi.org/10.1007/s00772-008-0663-z

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