Cannulation of the axillary artery for cardiopulmonary bypass: safeguards and pitfalls

Sinclair, Michael C.; Singer, Raymond L; Manley, Norman J; Montesano, Ralph M

doi:10.1016/s0003-4975(02)04497-1

Cited by 82 publications

(84 citation statements)

References 5 publications

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“…Our early outcomes in the TAA group, 4.3% mortality and 11% stroke, are acceptable compared with other reports not only about FA cannulation, 25) and ascending cannulation, [15][16][17][18] but also with axillary cannulation, [8][9][10] in the treatment of AAAD. As described above, there are advantages and disadvantages to each cannulation technique.…”

Section: Discussionsupporting

confidence: 50%

“…However, this technique is time consuming and not always safe or reliable. [8][9][10] Using a peripheral artery requires another skin incision in addition to median sternotomy, and requires a longer time to perform due to the more complicated procedures. Using a small artery might cause local complications, including dissections of another artery and insufficient flow, and often requires a side graft sewn to the vessel.…”

Section: Discussionmentioning

confidence: 99%

“…Using a small artery might cause local complications, including dissections of another artery and insufficient flow, and often requires a side graft sewn to the vessel. 13,14) Recently, direct cannulation into the dissected ascending aorta has been reported by several surgeons. [15][16][17][18] This technique can be performed rapidly without injury to the peripheral arteries, but there are concerns that it may increase the risks of rupture, extension of the dissection and malperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…If the axillary is small, CPB flow might be insufficient and there is a risk of injury. [8][9][10] In the emergency cases like aortic dissection, adequate evaluation was not performed for peripheral arteries, the small and atherosclerotic peripheral arteries were not suitable for enough CPB flow. Since October 2004, transapical aortic (TAA) cannulation technique was introduced and has been performed for AAAD in our institute for ten years.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Suenaga

Sato

Fumoto

et al. 2015

ATCS

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consecutive patients with AAAD were underwent the ascending aortic replacement at Nagasaki Kouseikai Hospital. These patients were divided into two groups according to the cannulation site, FA cannulation (n = 34) and TAA cannulation (n = 46). Early and mid-term outcomes were compared between two groups. Result: Preoperative patient characteristics were almost comparable between groups. The time from skin incision to starting cardiopulmonary bypass (CPB) was significantly shorter in the TAA group (45 ± 16 vs 23 ± 5.1 min; P <0.001). There were no significant differences in post-operative cerebral infarction in two groups (17% versus 11%; P = NS). The operative mortality rate was 8.8% in FA group and 4.3% in TAA group (P = NS). During follow up (mean, 6.8 years), survival at 3 years and 5 years was 77.4% and 71.9% in TAA group and 76.3% and 73.8% in FA group, respectively. Conclusion: The postoperative morbidity and mortality between the two groups were almost the same. TAA cannulation for acute Type A aortic dissection is faster, easy and safe with acceptable early and mid-term outcome.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Suenaga

Sato

Fumoto

et al. 2015

ATCS

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“…It is recommended to cannulate the axillary artery through a prosthetic graft previously anastomosed to the artery because it prevents damage to the arterial wall especially in the case of small caliber arteries (7,8).…”

Section: Hypothermiamentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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General Preoperative Considerations and Preparation of the Patient for Surgery

2020

Manual of Perioperative Care in Adult Cardiac Surgery

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Cannulation of the axillary artery for cardiopulmonary bypass: safeguards and pitfalls

Cited by 82 publications

References 5 publications

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Intraoperative care for aortic surgery using circulatory arrest

General Preoperative Considerations and Preparation of the Patient for Surgery

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