Article

Right axillary cannulation in the left thoracotomy for thoracic aortic aneurysm

First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
The Annals of Thoracic Surgery (Impact Factor: 3.63). 08/2000; 70(1):311-3. DOI: 10.1016/S0003-4975(00)01382-5
Source: PubMed

ABSTRACT Perfusion from the femoral artery is commonly used in the open proximal method of performing distal aortic arch aneurysm repair or Stanford type B aortic dissection repair under circulatory arrest through left thoracotomy. However, it is associated with a significant risk of retrograde emboli or malperfusion, and with other problems including a restricted time of circulatory arrest to the brain and difficulties in de-airing from the arch branches and proximal ascending aorta. To overcome these problems, we developed a method of performing right axillary perfusion through left thoracotomy.

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Available from: Nobuya Zempo, Jan 02, 2015
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    • "We believe that retrograde perfusion from the femoral artery to perform deep hypothermic circulatory arrest is a factor responsible for stroke in descending aortic operations without cross-clamping of the aorta. We have therefore, recently been using ascending aortic cannulation or right axillary artery perfusion with graft to achieve proximal aortic perfusion with passive cerebral flow for distal arch and descending aortic operations through a left thoracotomy [14] [15]. "
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    ABSTRACT: The risk of stroke caused by dislodgment of loose atheromatous plaque or mural emboli is increased by cross-clamping of the aorta. Some patients undergo descending thoracic aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. The objective of this study was to determine the influence of proximal aortic cross-clamping in arteriosclerotic aneurysm or dissecting aneurysm repair. Between May 1984 and May 2003, 81 patients underwent elective surgery for distal arch or descending aortic aneurysm repair with proximal aortic cross-clamping between the left common carotid artery and the left subclavian artery. To evaluate the influence of the proximal aortic cross-clamping, patients were divided into two groups: patients who had undergone arteriosclerotic aneurysm repair (group I, n=25) and patients who had undergone dissecting aneurysm repair (group II, n=56). Eight (9.9%) of the 81 patients had a stroke. Six strokes occurred in operations for arteriosclerotic aneurysm repair group I and two strokes occurred in operations for dissecting aneurysm repair group II (24 vs 3.6%; p=0.009). In-hospital mortality rates were 12% in group I and 8.9% in group II (p=0.70). Major postoperative complications included renal failure requiring hemodialysis (in 4.2% of the patients in group I and in 8.3% of the patients in group II, p=0.99) and pulmonary complication (in 20% of the patients in group I and in 16% of the patients in group II, p=0.67). Cross-clamping between head vessels should be avoided if at all possible when operating on patients who have arteriosclerotic descending thoracic aneurysms.
    European Journal of Cardio-Thoracic Surgery 05/2005; 27(4):622-5. DOI:10.1016/j.ejcts.2004.11.028 · 2.81 Impact Factor
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    • "Transapical aortic cannulation is not limited to aortic dissection and the location of a cannula or aortic valve regurgitation can be evaluated by transesophageal or epiaortic echocardiography. To achieve antegrade flow, some applications, such as axilloaxillary cardiopulmonary bypass [5], innominate artery cannulation [6], right axillary cannulation in the left thoracotomy [7], and transapical cannulation in pediatric patients [8] have been reported. We performed 20 axillary artery and three transapical aortic cannulations between July 1992 and May 2001 according to our indications. "
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    ABSTRACT: We present an experience with axillary artery and transapical aortic cannulation for cardiopulmonary bypass according to our indication. We could simply achieve antegrade flow using the two methods with satisfactory result.
    European Journal of Cardio-Thoracic Surgery 06/2003; 23(5):842-3. DOI:10.1016/S1010-7940(03)00076-9 · 2.81 Impact Factor
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    ABSTRACT: Aortik ark ameliyatları sırasında uygulanan beyin koruma-sına ilişkin fizyolojinin ve serebral hasarın anlaşılma düze-yindeki artış son 30 yılda koruyucu yöntemlerde önemli gelişmelere yol açmıştır. Hipotermi tüm mevcut beyin koruma yöntemlerinin en temel bileşenidir. Derin hipo-termik dolaşım arrestinin sağladığı şartlar altında rekons-trüksiyonun güvenle yapılması için gereken zamanın sınır-lı olduğu uzun süredir bilinmektedir. Tüm diğer yardımcı yöntemler, yani antegrad veya retrograd beyin perfüzyonu esas olarak dolaşım arrestine alternatif olarak veya güvenli dolaşım aresti süresini uzatmak amacıyla geliştirilmiştir. Retrograd ve bir ölçüde antegrad beyin perfüzyonu eklen-mesi ile bile "toplam beyin koruma zamanı"nı sınırlamak amacıyla ameliyatı hızlıca tamamlamak konusunda ciddi bir süre baskısı vardır. Aortik ark rekonstrüksiyonundaki cerrahi basamaklar bu temel gereksinime cevap olarak modifiye edilmiştir. Ameliyatın yürütülüşündeki deği-şiklikler perfüzyon için kullanılan arteriyel kanülasyon bölgelerini de içermektedir. Ark rekonstrüksiyonundaki yenilikçi adımlar ve perfüzyon yollarındaki değişiklikler eşzamanlı olarak gerçekleştirilmiştir ve bunların her ikisi de bu karmaşık ameliyatların sonuçlarında iyileşme olması yönünde ilave bir etkide bulunmuştur. Aşağıdaki makalede bu yeniliklerin tarihsel açıdan bir özeti sunulmaktadır ve bunu takiben, bu yeniliklerin bazılarını içeren ve sürekli antegrad beyin perfüzyonu sağlayan ve beyin perfüzyonu-nun kesildiği süreleri neredeyse tamamen ortadan kaldıran ve halen arkus replasmanında kullandığımız bir teknik anlatılmaktadır. Anah tar söz cük ler: Aort, azalan; aortik ark; kardiyopulmoner baypas; merkezi sinir sistemi; hipotermi. Increasing understanding of the mechanisms of cerebral injury and physiology of brain protection during operations on the aortic arch has led to important developments of protective methods in the last 30 years. Hypothermia is the principal element of all current methods of brain protection. The limited time available for safe conduct of the reconstruction under the conditions provided by deep hypothermic circulatory arrest was appreciated early on. All other adjunctive methods, i.e. selective antegrade cerebral perfusion or retrograde cerebral perfusion were originally developed as an alternative to circulatory arrest or in an attempt to safely prolong the duration of the circulatory arrest. Even with the adjuncts of retrograde cerebral perfusion and to a lesser extent selective cerebral perfusion, there is a serious time pressure to complete the operation rapidly in order to limit the period of "total cerebral protection time". Surgical steps in the reconstruction of the aortic arch were modified in response to this essential requirement. The changes in the conduct of the operation also involved the sites of arterial inflow for perfusion. The innovative steps in the reconstruction of the arch and the changes in the perfusion routes occurred simultaneously and both had an additive effect in the improved outcome of these complex operations. The following is a synopsis of these innovations from a historical point of view followed by the description of our preferred current technique of arch replacement which incorporates some of these innovations and provides continuous antegrade cerebral perfusion and virtually eliminates any period of interruption of brain perfusion.
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