Should we change the cannulation site for right subclavian artery cannulation? An experimental study with a newly designed cannula

Cakir, Habib; Kestelli, Mert; Yurekli, Ismail; Eygi, Börteçin; İşcan, Şahin; Işık, Yasemin; Asar, Kamil; Ogut, Hasan

doi:10.1177/0267659116649254

Perfusion

2016

DOI: 10.1177/0267659116649254

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Should we change the cannulation site for right subclavian artery cannulation? An experimental study with a newly designed cannula

Habib Cakir

Mert Kestelli

Ismail Yurekli

et al.

Abstract: Higher cerebral perfusion readings were obtained with our newly designed bidirectional cannula introduced via the innominate artery compared to standard cannulation through the right subclavian artery.

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“…in East-Asia.Cakir et al have demonstrated beneficial perfusion effects of a bidirectional novel innominatecannula in an experimental model, achieving higher perfusion readings than with AxS approach. This experimental model well supports our outcomes that perfusion in close vicinity of both carotid origins leads to most favourable cerebral supply in aortic surgery(84).Moizumi et al could not use AxS access in 5.5% of their aortic dissection cohort, as pathological changes extended into the axillary artery(85). Our first experience with the Seldinger technique was also a patient having dissection in all limb arteries(69).…”

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New techniques and principles in acute aortic pathologies requiring emergency surgical interventions

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Aortic surgery, especially for pathologies requiring urgent surgical intervention has undergone significant changes in the past twenty years, leading to major improvement in short-and long-term outcomes. This thesis aims to provide a comprehensive, up-to-date overview on clinical characteristics of acute aortic syndrome, with special emphasis on current operative treatment possibilities, including well-established and novel, innovative surgical approaches. Within this scheme, further specific goals are to analyse different cannulation and perfusion options, the role of core temperature management during hypothermic circulatory arrest and impact of age-related differences in surgical approach of AAS. Ultrasound-guided direct cannulation on the concavity of aortic arch applying Seldinger technique is a reliable method in dissection repairs. Prompt antegrade perfusion provides not only cerebral, but also peripheral organ and tissue protection, which is an advantage in this high-risk group of patients. This alternative arterial inflow technique can be applied for prompt establishment of cardiopulmonary bypass in type A dissections or other aortic emergencies, especially during haemodynamic instability. We have proven that tympanic temperature measurements correlate with arterial blood temperature monitoring during aortic surgery applying hypothermic circulatory arrest, therefore, should replace bladder and rectal measurements. Early diagnosis and aggressive surgical approach without delay is a key factor in effective treatment for aortooesophageal fitulas. Endovascular treatment is essential to save the patient, but as a standalone procedure often ends-up with life threatening mid-term graft infection. Eliminating the source of bleeding as an emergency, resecting the oesophagus urgently to prevent sepsis and reconstructing the gastrointestinal continuity as an elective case after having the inflammatory processes settled seems to justify the sequence of endovascular aortic repair and subtotal oesophageal resection, followed by a gastro-oesophageal reconstruction, as an effective surgical approach. More frequent proximal and distal progression of the dissection flap occurs in younger patients with acute type A aortic dissection. Older age is associated with a lower probability of an intimal tear at the level of sinus of Valsalva. These findings, associated with prognostic implications, account for the choice of more radical proximal procedures for repair of aortic dissection in younger patients.

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confidence: 76%

New techniques and principles in acute aortic pathologies requiring emergency surgical interventions

Göbölös¹

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Should we change the cannulation site for right subclavian artery cannulation? An experimental study with a newly designed cannula

Abstract: Higher cerebral perfusion readings were obtained with our newly designed bidirectional cannula introduced via the innominate artery compared to standard cannulation through the right subclavian artery.

Cited by 1 publication

References 7 publications

New techniques and principles in acute aortic pathologies requiring emergency surgical interventions

New techniques and principles in acute aortic pathologies requiring emergency surgical interventions

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