101
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Kamiya H, Kallenbach K, Halmer D, Ozsöz M, Ilg K, Lichtenberg A, Karck M. Comparison of ascending aorta versus femoral artery cannulation for acute aortic dissection type A. Circulation 2009; 120:S282-6. [PMID: 19752380 DOI: 10.1161/circulationaha.108.844480] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The site of cannulation for repair of ascending aortic dissection remains controversial. We present our experience with ascending aortic cannulation for acute aortic dissection type A. METHODS AND RESULTS From January 1988 to September 2007, we operated on 242 patients for acute aortic dissection type A. Medical records of 235 patients who received ascending aortic cannulation or femoral cannulation were retrospectively reviewed. Long-term follow-up was complete in 97% of patients. Cannulation was accomplished in 82 patients through the ascending aorta and in 153 patients through the femoral artery. Preoperative patient characteristics were almost comparable between groups. Similarly, there were no differences in preoperative patient characteristics and intraoperative parameters including operation time, bypass time, cross-clamp time, hypothermic circulatory arrest time, and percentage of total arch replacement. The 30-day mortality rate was 14% in the aortic group and 23% in the femoral group (P=0.07), and incidence of stroke was 4.9% in the aortic group and 4.5% in the femoral group (P=0.86). During follow-up (mean, 5.5 years), survival at 5 years and 10 years was 65% and 41% in the aortic group and 64% and 46% in the femoral group, respectively (P=0.97). CONCLUSIONS The cannulation site should be chosen according to the patient's pathology and status, and the present study suggests that ascending cannulation in patients with acute aortic dissection type A can be a safe alternative, offering acceptable early and long-term outcomes.
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Affiliation(s)
- Hiroyuki Kamiya
- Department of Cardiac Surgery, University Hospital Heidelberg, Germany
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102
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Numata S, Thomson DS, Seah P, Singh T. Simplified Cerebral Protection Using Unilateral Antegrade Cerebral Perfusion and Moderate Hypothermic Circulatory Arrest. Heart Lung Circ 2009; 18:334-6. [DOI: 10.1016/j.hlc.2009.03.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 03/23/2009] [Accepted: 03/28/2009] [Indexed: 11/25/2022]
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103
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Advantages of right axillary artery cannulation in surgical management of thoracic aorta dissection involving the aortic arch. COR ET VASA 2009. [DOI: 10.33678/cor.2009.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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104
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Siminelakis SN, Baikoussis NG, Papadopoulos GS, Beis IP. Axillary Artery Cannulation for Cardiopulmonary Bypass during Surgery on the Ascending Aorta and Arch. J Card Surg 2009; 24:301-4. [DOI: 10.1111/j.1540-8191.2008.00796.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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105
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Reevaluation of Direct True Lumen Cannulation in Surgery for Acute Type A Aortic Dissection. Ann Thorac Surg 2009; 87:1182-6. [DOI: 10.1016/j.athoracsur.2009.01.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 01/12/2009] [Accepted: 01/13/2009] [Indexed: 11/20/2022]
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106
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Battaloglu B, Erdil N, Nisanoglu V. Axillary Artery Perfusion in Acute Type A Aortic Dissection Repair. J Card Surg 2008; 23:693-6. [DOI: 10.1111/j.1540-8191.2008.00754.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bektas Battaloglu
- Department of Cardiovascular Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - Nevzat Erdil
- Department of Cardiovascular Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - Vedat Nisanoglu
- Department of Cardiovascular Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
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107
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Ogino H, Sasaki H, Minatoya K, Matsuda H, Tanaka H, Watanuki H, Ando M, Kitamura S. Evolving arch surgery using integrated antegrade selective cerebral perfusion: Impact of axillary artery perfusion. J Thorac Cardiovasc Surg 2008; 136:641-8; discussion 948-9. [DOI: 10.1016/j.jtcvs.2008.02.089] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/21/2007] [Accepted: 02/19/2008] [Indexed: 11/30/2022]
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108
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Shimokawa T, Takanashi S, Ozawa N, Itoh T. Management of intraoperative malperfusion syndrome using femoral artery cannulation for repair of acute type A aortic dissection. Ann Thorac Surg 2008; 85:1619-24. [PMID: 18442550 DOI: 10.1016/j.athoracsur.2008.01.048] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 01/15/2008] [Accepted: 01/17/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The site of cannulation for repair of ascending aortic dissection remains controversial. The objective of this study was to evaluate the incidence and management of intraoperative malperfusion syndrome using femoral cannulation for repair of acute type A aortic dissection. METHODS Between May 2002 and February 2007, 107 patients with initial femoral artery cannulation for the repair of type A aortic dissection were enrolled in this study. The mean age was 63.7 +/- 11.8 years; 51 patients were female. Preoperative findings indicated malperfusion in 16 patients. Intraoperative malperfusion syndrome was diagnosed by both radial arterial pressure measurements and transesophageal echocardiography. Clinical outcomes, including specific operative procedures and complications related to the cannulation, were assessed. RESULTS The ascending aorta was replaced in 59 patients, hemiarch in 16, and total aortic arch in 32. Intraoperative malperfusion syndrome was noted in 3 patients (lowering of radial pressure in 2, obstruction of the true lumen in 1) at the initiation of cardiopulmonary bypass. After immediately switching to transventricular cannulation, the surgical replacement was successfully performed. The remaining 104 patients underwent surgery during femoral artery bypass without perfusion abnormalities. There was 1 in-hospital death (0.9%), but no deaths among the malperfusion patients. Cerebrovascular deficit occurred in 7 patients (6.5%). One vascular and 3 wound complications occurred related to the femoral cannulation. CONCLUSIONS During the repair of acute ascending aortic dissection, malperfusion syndrome related to femoral artery cannulation has an acceptable incidence, and can be managed under appropriate intraoperative monitoring, particularly at the initiation of cardiopulmonary bypass.
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Affiliation(s)
- Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
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109
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Immer FF, Moser B, Krähenbühl ES, Englberger L, Stalder M, Eckstein FS, Carrel T. Arterial access through the right subclavian artery in surgery of the aortic arch improves neurologic outcome and mid-term quality of life. Ann Thorac Surg 2008; 85:1614-8; discussion 1618. [PMID: 18442549 DOI: 10.1016/j.athoracsur.2007.11.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 11/09/2007] [Accepted: 11/09/2007] [Indexed: 12/27/2022]
Abstract
BACKGROUND We have shown that selective antegrade cerebral perfusion improves mid-term quality of life in patients undergoing surgical repair for acute type A aortic dissection and aortic aneurysms. The aim of the study was to assess the impact of continuous cerebral perfusion through the right subclavian artery on immediate outcome and quality of life. METHODS Perioperative data of 567 consecutive patients who underwent surgery of the aortic arch using deep hypothermic circulatory arrest have been analyzed. Patients were divided into three groups, according to the management of cerebral protection. Three hundred eighty-seven patients (68.3%) had deep hypothermic circulatory arrest with pharmacologic protection with pentothal only, 91 (16.0%) had selective antegrade cerebral perfusion and pentothal, and 89 (15.7%) had continuous cerebral perfusion through the right subclavian artery and pentothal. All in-hospital data were assessed, and quality of life was analyzed prospectively 2.4 +/- 1.2 years after surgery with the Short Form-36 Health Survey Questionnaire. RESULTS Major perioperative cerebrovascular injuries were observed in 1.1% of the patients with continuous cerebral perfusion through the right subclavian artery, compared with 9.8% with selective antegrade cerebral perfusion (p < 0.001) and 6.5% in the group with no antegrade cerebral perfusion (p = 0.007). Average quality of life after an arrest time between 30 and 50 minutes with continuous cerebral perfusion through the right subclavian artery was significantly better than selective antegrade cerebral perfusion (90.2 +/- 12.1 versus 74.4 +/- 40.7; p = 0.015). CONCLUSIONS Continuous cerebral perfusion through the right subclavian artery improves considerably perioperative brain protection during deep hypothermic circulatory arrest. Irreversible perioperative neurologic complications can be significantly reduced and duration of deep hypothermic circulatory arrest can be extended up to 50 minutes without impairment in quality of life.
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Affiliation(s)
- Franz F Immer
- Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland.
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110
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Anastasiadis K, Antonitsis P, Papakonstantinou C. Innominate artery cannulation. Multimed Man Cardiothorac Surg 2008; 2008:mmcts.2008.003418. [PMID: 24415684 DOI: 10.1510/mmcts.2008.003418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Innominate artery cannulation is indicated mainly for surgery which involves aortic root and aortic arch when pathology precludes standard cannulation of the ascending aorta. Thus, it can be used as the procedure of choice in cases of ascending aortic aneurysm, type A aortic dissection, porcelain aorta and reoperation for coronary or aortic surgery. It is performed through a standard median sternotomy, hence avoiding the complications of a second incision. It provides antegrade systemic and cerebral flow that is associated with improved distal organ perfusion and reduced rate of retrograde cerebral embolization compared to femoral arterial cannulation, Moreover, it eliminates potential complications from axillary artery cannulation, such as dissection, upper extremity malperfusion and brachial plexus injury. It is contraindicated in cases of excessive calcification and acute dissection clearly involving the innominate artery.
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Affiliation(s)
- Kyriakos Anastasiadis
- Department of Thoracic and Cardiovascular Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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111
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Farhat F, Sassard T, Scalabre A, Greffe G, Cannesson M, Jegaden O. Canulations et circuits en chirurgie aortique : complications des canulations artérielles. Ing Rech Biomed 2007. [DOI: 10.1016/s1297-9562(07)78719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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112
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Di Eusanio M, Ciano M, Labriola G, Lionetti G, Di Eusanio G. Cannulation of the innominate artery during surgery of the thoracic aorta: our experience in 55 patients. Eur J Cardiothorac Surg 2007; 32:270-3. [PMID: 17553687 DOI: 10.1016/j.ejcts.2007.03.050] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 03/22/2007] [Accepted: 03/26/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Alternative cannulation sites such as the right/left axillary artery, the ascending aorta and aortic arch have been recently preferred to the femoral artery to improve neurologic outcome in patients undergoing surgery of the thoracic aorta. In 2004, we started to select the innominate artery as an arterial cannulation site for CPB and antegrade cerebral perfusion institution. Here we present our preliminary experience with 55 patients. METHODS Between November 2004 and 2006, 55 patients (mean age 60+/-14 years) underwent surgery on the thoracic aorta using the innominate artery as a site for arterial cannulation. Indication for surgery was a degenerative aneurysm in 49 (89.1%), an acute type A dissection in 2 patients (3.6%), a post-dissection aneurysm in 3 (5.4%), a supravalvular aortic stenosis in 1 patient (1.8%). Operative procedure included total arch replacement (n=9), hemiarch replacement (n=6), ascending aorta replacement (n=21), Bentall procedure (n=18) and aortoplasty with patch (n=1). Mean CPB and cross clamp times were 131+/-60 and 95+/-29 min, respectively. Mean cerebral perfusion time was 54+/-26 min. RESULTS The hospital mortality rate was 3.6%. There were no permanent neurologic dysfunction and one (1.8%) temporary neurological dysfunction. CONCLUSION Our results with the cannulation of the innominate artery were encouraging. This provides the same advantages of the axillary artery cannulation with greater simplicity and avoiding extra surgical incisions which may be site for local complications. It may represent a valid option for CPB and antegrade cerebral perfusion institution in aortic procedures.
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Affiliation(s)
- Marco Di Eusanio
- Department of Cardiovascular Surgery, Santa Maria Hospital, Bari, Italy.
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113
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Gulbins H, Pritisanac A, Ennker J. Axillary Versus Femoral Cannulation for Aortic Surgery: Enough Evidence for a General Recommendation? Ann Thorac Surg 2007; 83:1219-24. [PMID: 17307506 DOI: 10.1016/j.athoracsur.2006.10.068] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 10/26/2006] [Accepted: 10/26/2006] [Indexed: 12/01/2022]
Abstract
There is a trend towards cannulation of the axillary artery for extracorporeal circulation in patients requiring aortic arch surgery. We analyzed the published data comparing axillary and femoral cannulation for safety and outcome. End points were death; stroke, neurologic, and vascular complications; and malperfusion. Femoral cannulation is safe for extracorporeal circulation in patients without aortic arch surgery. In patients with type A dissections, malperfusion may occur owing to retrograde perfusion of the false lumen and subsequent occlusion of the origin of the supra aortic vessels. Cannulation of the axillary/subclavian artery results in antegrade flow, at least in the right carotid artery, with the possibility of antegrade cerebral perfusion during aortic arch repair. There was a trend towards improved neurologic outcome when the axillary artery was used for extracorporeal circulation in such patients. When different techniques were compared, the use of a side graft for axillary cannulation reduced the complication rate. The lack of randomized trials and the high variety of inclusion criteria in the different studies do not allow a general recommendation for the use of the axillary artery as cannulation site.
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Affiliation(s)
- Helmut Gulbins
- Department of Cardiac Surgery, Heart Center Lahr, Lahr/Schwarzwald, Germany.
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114
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Reece TB, Tribble CG, Smith RL, Singh RR, Stiles BM, Peeler BB, Kern JA, Kron IL. Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg 2007; 133:428-34. [PMID: 17258578 DOI: 10.1016/j.jtcvs.2006.09.059] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2006] [Revised: 09/09/2006] [Accepted: 09/20/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The site of cannulation for the repair of ascending aortic dissection remains controversial. It is not clear whether cannulation of the dissected vessel is safe or even preferred. We hypothesized that cannulation of the dissected aorta could be done safely with acceptable complication and mortality rates in this high-risk population. METHODS The charts of repairs of acute ascending aortic dissections (n = 70) from 1996 to 2005 were reviewed. Cannulation was accomplished in 24 patients via the dissected aorta (central) and in 46 patients through cannulation of the femoral or axillary artery (peripheral). All were converted to sidearm cannulation of the graft for reperfusion. Groups were compared on the basis of comorbidities in addition to mortality, complications, hospital stays and final disposition. RESULTS The groups were comparable on the basis of age and preoperative comorbidities. Similarly, there were no differences in bypass time, crossclamp time, or hypothermic circulatory arrest time between groups. Hospital mortality and postoperative complications, including stroke, were similar between groups, but the peripheral group experienced more cardiac events (peripheral 15% vs central 0%; P < .05) and higher mortality than the central group (peripheral 19.5% vs central 4.2%; P < .05). CONCLUSIONS Direct cannulation of the dissected aorta was safe compared with peripheral cannulation in these patients. Inasmuch as these data demonstrate that cannulation of the dissected ascending aorta is safe, this technique can be used to tailor the cannulation approach to specific anatomic and patient characteristics that might optimize postoperative outcomes in this disease entity.
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Affiliation(s)
- T Brett Reece
- University of Virginia, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Charlottesville, Va, USA.
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115
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Sáez de Ibarra JI, Enríquez F, Tarrío RF, Barril R, Bonnin O. Canulación axilar mediante prótesis de Dacron en cirugía del arco y la aorta ascendente. Rev Esp Cardiol (Engl Ed) 2007. [DOI: 10.1016/s0300-8932(07)74989-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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116
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Urbanski PP, Lenos A, Lindemann Y, Weigang E, Zacher M, Diegeler A. Carotid artery cannulation in aortic surgery. J Thorac Cardiovasc Surg 2006; 132:1398-403. [PMID: 17140965 DOI: 10.1016/j.jtcvs.2006.07.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Revised: 07/07/2006] [Accepted: 07/12/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Carotid artery cannulation was initially established at our clinic for surgery of acute aortic dissection, and it became the standard approach for procedures in which circulatory arrest is necessary. The aim of the study was to evaluate this method's efficiency regarding postoperative outcomes after the first 100 procedures. METHODS Between July 2002 and October 2005, 100 patients underwent aortic surgery using carotid artery cannulation by a side graft for arterial return with a mean flow rate of 4.6 +/- 0.5 L/min. There were 27 patients with acute and 2 with chronic type A aortic dissection. Sixteen patients had had prior cardiac surgery. During circulatory arrest, the arterial line was used for unilateral cerebral perfusion in moderate hypothermia (mean rectal temperature 28 degrees C +/- 1.6 degrees C) with a mean flow rate of 0.85 +/- 0.2 L/min. RESULTS Carotid artery cannulation offered adequate arterial return in all patients. In no case was a switch to another cannulation site necessary for arterial return. Furthermore, no complications related to the cannulation site were observed. One patient with acute dissection and 1 with chronic aneurysm died during the early postoperative course. Thus, 30-day mortality was 2.0% for the whole group and 3.7% for the dissection group. Two patients with severe calcification of the aortic valve had strokes. There were no strokes in the dissection group, although there were preoperative signs of cerebral malperfusion in 4 patients. CONCLUSIONS Carotid artery cannulation is a fast, safe, and efficient method of arterial cannulation even in very obese patients. In addition, it simplifies the procedure of unilateral cerebral perfusion through the arterial line during circulatory arrest, making it completely unnecessary to interrupt cerebral perfusion.
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Affiliation(s)
- Paul P Urbanski
- Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
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Kanülierung der Arteria carotis communis bei akuter Typ-A-Aortendissektion. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2006. [DOI: 10.1007/s00398-006-0548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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