Cannulation of the right axillary artery for surgery of acute type A aortic dissection

Pašić, Miralem; Schubel, Jens; Bauer, Matthias; Yankah, Charles; Kuppe, Hermann; Weng, Yuguo; Hetzer, Roland

doi:10.1016/s1010-7940(03)00307-5

Cited by 74 publications

(56 citation statements)

References 8 publications

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“…Mortality rate in the group of axillary arterial perfusion was excellent despite 25% of preoperative malperfusion. 6) As to antegrade aortic perfusion, an alternative perfusion site is transapical one. Wada and coworkers showed the utility of transapical cannulation in a repair of AAD.…”

Section: Discussionmentioning

confidence: 99%

“…However, we concern the possible complications of retrograde perfusion such as retrograde cerebral embolization or organ malperfusion. 4,6) Our policy is that we manage to establish antegrade aortic perfusion as possible as we can because of establishment of antegrade aprtic perfusion and prevention of concerned complications.…”

Section: Discussionmentioning

confidence: 99%

“…4,6) In contrast, the use of the right axillary artery can provide not only antegrade aortic perfusion during cardiopulmonary bypass but also continuous antegrade cerebral perfusion during circulatory arrest. 4,6,7) Our current strategy of arterial perfusion is the right axillary artery perfusion with an 8-mm prosthetic graft in a repair of AAD. In this study, we aim to investigate operative outcomes in our strategy of arterial perfusion in a repair of AAD and whether the duration of ACP affects early outcomes.…”

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confidence: 99%

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Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Fukunaga

Saji

Kanemitsu

et al. 2015

ATCS

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IntroductionType A acute aortic dissection (AAD) is still a devastating disease, which mortality rate following medical managements reaches to 50% within the first 48 h. 1) The mortality rate associated with AAD after surgery has decreased, but it reached to roughly 20% worldwide. 2) In Japan, hospital mortality rate after an emergency surgery for AAD was 9.2% in 2010. 3) Antegrade cerebral perfusion (ACP) is one of the techniques for cerebral protection during proximal aortic surgery. This technique has been applied to a repair of AAD and effective circulation management could be achieved by Comas et al. 2) Controversy that which arterial cannulation site is optimal in a repair of AAD exists. 4,5) Femoral artery is the usual cannulation site for cardiopulmonary bypass in a repair of AAD, 6) on the other hand, the retrograde perfusion via the femoral artery causes retrograde thromboembolism from atheromatous debris in the thoracic and was performed in 34 patients. Mean age was 64.5 ± 13.7 years of age. Preoperative shock status was in three due to cardiac tamponade. Organ malperfusion occurred in 11 patients preoperatively. Mean follow-up period was 9.6 ± 8.4 months and follow-up rate was 100%. Results: Hospital mortality rate was 8.8%. No newly required hemodialysis and new onset of temporary or permanent neurologic deficits were present in survivors. There were no statistically significant differences of mortality rate, new onset of permanent or temporary neurologic deficits and distal organ dysfunction between ACP duration <60 min and ≥60 min. The 12-month survival was 84.4% ± 6.4%. And, freedom from aorta-related events at 12 and 18 months were 100% ± 0.0% and 88.9% ± 10.5%, respectively. Conclusions: The duration of ACP via right axillary artery does not affect early outcomes following a repair of AAD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Fukunaga

Saji

Kanemitsu

et al. 2015

ATCS

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“…In addition, during axillary artery cannulation, problems such as cerebral ischemia and ischemia of the upper extremities can occur; thus, it may not be useful in all cases. [12][13][14] Furthermore, the use of cannulation of the ascending aorta to treat acute aortic dissection has also been reported. 4,5,15,16) Some institutions (such as ours) use the Seldinger technique for artery puncture and cannulation, 15,17) while others use direct cannulation for ordinary open heart surgery.…”

Section: Intraoperative Parameter(s) (Table 2)mentioning

confidence: 99%

Direct and Transapical Central Cannulation for Acute Type A Aortic Dissection

Wada

Matsumura

Minematsu

et al. 2014

Annals of Vascular Diseases

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Objective: The choice of cannulation site for the treatment of acute Stanford type A aortic dissection is much debated. We believe that central cannulation is quick to perform, easy to use, and safe to manage acute type A aortic dissection. Materials and Methods: We retrospectively investigated 26 cases of acute aortic dissection performed using two different central cannulation methods between April 2011 and March 2012. Direct ascending aortic cannulation was performed using the Seldinger technique in 20 patients, and transapical ascending aortic cannulation was performed in six patients in whom puncture was difficult. Results: Patients were 21-86 years old (mean age, 67 years). The surgical techniques used to treat aortic dissection were hemiarch repair in 21 patients and total arch replacement in 5 patients. The mean length of surgery was 393 min. One death (3.8%) was attributed to intestinal ischemia. Conclusion: During surgery for acute aortic dissection, central cannulation using either transapical or direct puncture can be performed quickly and safely, and satisfactory short-term outcomes can be obtained. Because acute aortic dissection can present with various conditions, there is no single perfect surgical or cannulation method; therefore, the choice of surgical procedure should be individualized for each patient.

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“…It is interesting to note that, even when atherosclerotic disease extensively involves the aorta up to the innominate artery, the axillary/subclavian artery is seldom affected [26,27].…”

Section: Right Axillary/right Subclavian Arterymentioning

confidence: 99%

Proteção cerebral: sítios de canulação arterial e vias de perfusão do cérebro

Dias¹,

Silva²,

Fiorelli³

et al. 2007

Rev Bras Cir Cardiovasc

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Brain perfusion for adequate cerebral protection has changed over the years. The limitations of the time during total circulatory arrest with deep hypothermia, the inefficient cerebral metabolism during retrograde perfusion and special care to prevent cerebral embolism during antegrade perfusion have resulted in the development of different methods of cerebral protection during the evolution of aortic arch operations. Antegrade cerebral perfusion associated with moderate hypothermia is today, considered the best option for cerebral protection. 236DIAS, RR ET AL -Cerebral protection: sites of arterial cannulation and brain perfusion routes Braz J Cardiovasc Surg 2007; 22(2): 235-240

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Cannulation of the right axillary artery for surgery of acute type A aortic dissection

Abstract: Cannulation of the right axillary artery improved the outcome of surgery for acute type A aortic dissection. However, postoperative complications occurred after both axillary and femoral artery cannulation.

Cited by 74 publications

References 8 publications

Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Direct and Transapical Central Cannulation for Acute Type A Aortic Dissection

Proteção cerebral: sítios de canulação arterial e vias de perfusão do cérebro

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