Frozen elephant trunkにおける末梢灌流―持続的灌流か間欠的灌流か

Efficacy of Distal Perfusion During Frozen Elephant Trunk Procedure：Continuous Perfusion Versus Intermittent Perfusion

Frozen elephant trunk（FET）は，広範囲胸部大動脈瘤や解離性大動脈瘤に対し一期的に瘤を処置できる画期的な手術法1）であり，その良好な初期・遠隔期成績から不可欠な治療法となっている2，3）．しかし，FETは胸部ステントグラフト内挿術（TEVAR）や従来の外科的血行再建術に比し脊髄虚血合併が多いとされ3），本法の臨床成績の向上にはこの問題の解決がもっとも重要な課題である．

Purpose：To compare the effectiveness of continuous distal perfusion （CDP） with that of intermittent distal perfusion （IDP） during frozen elephant trunk （FET） procedures.

Methods：There were 54 patients in the CDP group and 15 patients in the IDP group. There were no significant differences in preoperative characteristics between the two groups, but dissection was more common in the IDP group than in the CDP group, and the maximum aneurysmal diameter was larger in the CDP group than in the IDP group.

Results：Emergency surgery was significantly more common in the IDP group than in the CDP group. Operating time, cardiopulmonary bypass time, lower body arrest time, and aortic cross-clamp time were significantly longer in the IDP group. Postoperative paraparesis occurred in one case in each group, and temporary paraparesis occurred in two cases in the CDP group, with no significant differences, including in mechanical ventilation time. There were two in-hospital deaths, one due to respiratory failure and one due to ischemic colitis, in the CDP group and one due to multiple organ failure in the IDP group. Postoperative liver and renal functions did not differ significantly between the two groups.

Conclusion：IDP has proven to be almost as effective as CDP during FET for preventing spinal cord ischemia and maintaining respiratory, liver, and renal functions.