The strategy to avoid malperfusion of vital organs during operation for acute aortic dissection; multi-monitoring and right brachial artery perfusion

摘要

BACKGROUND: Malperfusion of vital organs is the most serious complication during cardiopulmonary bypass for acute aortic dissection. METHOD: From 2001 to 2006, 40 patients underwent operation for acute type A aortic dissection. Right brachial artery perfusion was performed in 20 patients. From May 2005, transesophageal echocardiography and cerebral oxygenation measured by near infrared spectroscopy were continuously monitored during operation. RESULTS: There were 3 in-hospital deaths and 3 brain infarction. Switching of blood flow during cardiopulmonary bypass occurred in 3 patients; 2 patients suffered from diffuse brain infarction while. in the other patient, switching of perfusion was detected at once by multi-monitoring and resolved by induction of right brachial artery perfusion. CONCLUSION: Close monitoring of cerebral oxygenation by near infrared spectroscopy, transesophageal echocardiography and right brachial artery perfusion are effective in operation for acute aortic dissection.