RESUMEN
<p><b>OBJECTIVE</b>To assess the clinical outcomes of brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for treatment of Stanford type A aortic dissection.</p><p><b>METHODS</b>Twenty-three patients with Stanford type A aortic dissection requiring arch replacement underwent brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique. The operations were performed within 72 h (20 cases) or 3-14 days (3 cases) after the onset of aortic dissection.</p><p><b>RESULTS</b>There was no perioperative death in these cases. The mean extracorporeal circulation time was 209∓52 min, the aortic cross clamp time was 85∓21 min, and the mean chest tube output within the first 24 h after the operation was 570∓263 mL; none of the patients required chest reopening for management of bleeding. Postoperative acute renal failure requiring hemodialysis occurred in 3 cases, transient neurologic dysfunction in 2 cases, paraplegia in case and hematosepsis in 1 case. No such complications as permanent neurologic deficit or postoperative visceral malperfusion occurred in these cases. All the patients survived and were discharged from hospital without experiencing severe complications in the follow-up for 6-18 months.</p><p><b>CONCLUSION</b>Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique is a safe and simple procedure with controllable bleeding and can serve as an optional procedure for aortic arch replacement.</p>
RESUMEN
Objective To investigate the effect of L-arginine (L-arg) on cerebral oxygen metabolism and ultrastructure during deep hypothermic circulatory arrest (DHCA) in experimental dogs. Methods Fifteen healthy adult mongrel dogs with both sexes, weighing (14.7±2.4)kg, were randomly divided into three groups (n=5): sham treated group, L-arg pretreated group (100mg/kg L-arg was given 60min before circulation arrest), L-arg and 7-Ni combined treated group (100mg/kg L-arg and 25mg/kg 7-Ni were given 60min before circulation arrest). Extracorporeal circulatory was established routinely, and DHCA commenced when the nasopharyngeal temperature was reduced to 18℃, then reperfusion began after 90min of DHCA. SjvO2, NO in plasma were measured 30min before DHCA and 0,45,90min after DHCA commencement and 60min after rewarming. The ultrastructural changes of cortex and hippocampal gyrus were also been observed with transmission electron microscope after the dogs were executed. Results Compared with sham-treated group, L-arg pretreatment combined with 7-Ni or not increased NO content in plasma, SjvO2 during DHCA, improved cerebral oxygen metabolism and reduced brain ultrastructural injury. There was a positive correlation between NO conten in plasma before arrest and SjvO2 after arrest (r=0.679,P=0.005). Conclusion L-arg pretreatment has cerebral protective effects and can improve cerebral oxygen metabolism during DHCA.