Objective To investigate the surgical approach and efficacy of reconstruction of the isolated left vertebral artery (ILVA) in single upper hemisternotomy for total aortic arch replacement. Methods From March 2017 to October 2023, patients who underwent total aortic arch replacement under single upper hemisternotomy in General Hospital of Northern Theater Command were selected. According to the presence of ILVA, they were divided into a conventional group and an ILVA group. All the ILVA group underwent intraoperative ILVA reconstruction. The perioperative clinical data between two groups were compared. Results A total of 504 patients were collected, including 471 males and 31 females, with an average age of 50.4±11.4 years. There was no increase in the duration of cardiopulmonary bypass or postoperative hospitalization in the ILVA group (n=31) compared to the conventional group (n=473), and the rates of perioperative complications and in-hospital mortality were not significantly different between the two groups. There were 2 (6.45%) patients of acute cerebral infarction and 2 (6.45%) patients of perioperative death in the ILVA group, with no spinal cord injuries. Conclusion ILVA reconstruction during total aortic arch replacement in single upper hemisternotomy is feasible, safe, and effective, and prioritizing off pump ILVA-left common carotid artery transposition.
目的總結75歲以上高齡冠心病患者行冠狀動脈旁路移植術（CABG）的圍手術期臨床經驗，以提高手術療效。 方法2014年2～6月沈陽軍區總醫院心外科為20例75～84歲冠狀動脈粥樣硬化患者行非體外循環冠狀動脈旁路移植術，其中男11例、女9例，主要病變均為三支冠狀動脈嚴重狹窄或伴左主干狹窄，其中5例患者伴急性心肌梗死，所有患者均為限期手術。分析全組手術時間、住院時間、圍手術期并發癥、術后結果等。 結果全組均采用左乳內動脈吻合前降支，大隱靜脈吻合其他分支，平均橋血管數量為3.2支；平均手術時間3.3 h；術后平均呼吸機輔助時間9.6 h；術后平均重癥監護時間26.4 h；術后平均住院時間為12.3 d。術后出現陣發性心房顫動3例；術后呼吸機輔助期間低氧血癥2例，術后因咳痰無力及誤吸并發嚴重肺炎1例；術后明顯腹脹、納差6例，其中1例因腹脹行短期胃腸減壓及完全胃腸道外營養，1例因納差再次入院治療；術后傷口愈合不良清創縫合1例。所有患者均痊愈出院，心功能改善，心絞痛癥狀消失。 結論對于高齡患者，非體外循環冠狀動脈旁路移植術療效滿意；胃腸功能、呼吸功能及手術耐受力為影響高齡患者圍手術期恢復較為突出的因素，應采取更為積極的治療和應對策略。