Axillary artery cannulation in ascending aortic pathologies

Abstract

Amaç: Bu çalışmada kardiyopulmoner bypass (KPB) için aksiller kanülasyonun sonuçları ve mortalite ve morbiditeye etki eden faktörler incelendi. Ça lış ma pla nı: Kasım 2006 -Ocak 2009 tarihleri arasında çıkan aort patolojileri nedeniyle ameliyata alınan 84 hasta (58 erkek, 26 kadın; ort. yaş 53.8±13.2 yıl; dağılım 20-77 yıl) aksiller kanülasyonla ameliyat edildi. Toplamda 84 hastaya 124 işlem uygulandı ve en sık uygulanan işlem 64 hastaya (%76.2) yapılan çıkan aort replasmanıydı. En sık ameliyat endikasyonu 51 hastada (%60.7) bulunan çıkan aort anevrizmasıydı. Üç hasta (%3.6) daha önce açık kalp ameliyatı geçirmişti. Hipotermik dolaşım arresti 51 hastada (%60.7) kullanıl-dı ve aksiller arter 75 hastada (%89.3) doğrudan, dokuz hastada (%10.7) ise bir yan greft aracılığıyla kanüle edildi. Bul gu lar: Ameliyat sonrasında hastaların üçünde (%3.6) sepsis, ameliyat sırası kanama ve düşük kardiyak debi sendromu nedeniyle hastane mortalitesi meydana geldi. Hastaların 10'unda (%11.9) nörolojik komplikasyonlar görüldü (8'inde geçici nörolojik disfonksiyon ve 2'sinde inme). Ortalama hastanede kalma süresi 5.1±5.6 (dağı-lım 1-46) gündü. Ameliyat sonrası ortalama takip süresi 10.3±5.5 (dağılım 1-15.5) aydı (toplam 68.5 hasta/yıl). Taburcu sonrası takip sürecinde mortalite görülmedi. Kanülasyon yöntemi ile mortalite ya da nörolojik komplikasyonlar arasında herhangi bir ilişki saptanmadı. So nuç:Aksiller arter arteriyel kanülasyon için güvenli bir yoldur ve aksiller yol ameliyat sonrası mortalite ve morbiditede artışa neden olmaz.Anah tar söz cük ler: Çıkan aort; aksiller arter kanülasyonu; selektif antegrad serebropleji. Background:We analyzed the results of axillary cannulation for cardiopulmonary bypass (CPB) and the factors affecting mortality and morbidity. Methods: Eighty-four patients (58 males, 26 females; mean age 53.8±13.2 years; range 20 to 77 years) were operated on for ascending aortic pathologies with axillary arterial cannulation between November 2006 and January 2009. Overall, 124 procedures were performed in 84 patients, and the most commonly performed procedure was the replacement of the ascending aorta which was employed in 64 patients (76.2%). The most common indication for operation was ascending aortic aneurysm that was present in 51 patients (60.7%). Three (3.6%) patients had previously undergone open heart surgery. Hypothermic circulatory arrest was used in 51 (60.7%) patients, and the axillary artery was cannulated directly in 75 (89.3%) patients and via a side graft in nine (10.7%) patients. Results: Postoperatively, three patients (3.6%) had in-hospital mortality because of sepsis, intraoperative bleeding, and low cardiac output syndrome. Neurological complications were seen in 10 (11.9%) patients (8 had transient neurological dysfunction and 2 had stroke). The mean duration of hospital stay was 5.1±5.6 (range 1 to 46) days. Postoperative follow-up was 10.3±5.5 (range 1 to 15.5) months on average (total of 68.5 patient/years). There was no mortality during the follow-up after discharge. No relationsh...

Advantages of upper brachial artery cannulation in aortic surgery

“…Cannulation of the axillary artery in aortic surgery has several advantages: the axillary artery is generally free from atherosclerosis; it eliminates the risk of retrograde embolization; it provides antegrade perfusion of the true lumen in aortic dissection; antegrade cerebral perfusion is never interrupted; and bihemispheric perfusion is assured. 6 However, the main complications of axillary artery cannulation are brachial plexus injury and axillary artery thrombosis. 2 Strauch and colleagues 7 reported a local complication rate of 4.9% in 284 patients when the axillary or subclavian artery was directly cannulated.…”

Isolated Aortic Root Aneurysms

“…After the usual preparations, standard central arterial cannulation is established through the distal ascending aorta or the lateral wall of the mid aortic arch. If any dissection is present at the ascending aorta, the arterial cannulation should be performed through a patent peripheral artery [33]. Venous cannulation is prepared using a thinner single two-staged venous cannula through the right atrial appendage or an appropriate venous cannula through the femoral vein, and venous return is maintained via a negative vacuum venous drainage system.…”

Stentless Bioprosthess for Aortic Valve Replacement in Calcific Aortic Stenosis

“…Aortic valve surgery can be performed through a median full sternotomy or upper ministernotomy with conventional or minimal skin incision. The distal ascending aorta cannulation is usually the standard approach in most patients, but the arcus aorta or axiller artery can be also cannulated when the ascending aorta should be replaced [28]. A single dual-stage venous cannula is inserted through the right atrium appendage.…”