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: 3.85). 08/2000; 70(1):311-3. DOI: 10.1016/S0003-4975(00)01382-5
Source: PubMed


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.
    Full-text · Article · May 2005 · European Journal of Cardio-Thoracic Surgery
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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.
    Full-text · Article · Jun 2003 · European Journal of Cardio-Thoracic Surgery
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    ABSTRACT: The conduct of partial left heart bypass or partial cardiopulmonary bypass (CPB) during surgery involving the descending thoracic aorta or thoracoabdominal aorta is one of the most unappreciated and misunderstood extracorporeal circulation procedures in cardiovascular surgery. It is different from conventional CPB, and although some uninitiated practitioners consider it simpler, it is in fact more complicated than conventional CPB and involves different concepts. It requires expertise and skill in regulating the flow, pressure, and oxygenation of blood going to both the proximal and distal parts of the body and management of the special bypass or shunt procedures used, specialized monitoring, and knowledge about the protection and preservation of organs both proximal and distal to the aortic clamping. It demands exquisite communication and understanding of the unique problems faced by the surgeon, anesthesiologist, and perfusionist.
    No preview · Article · Nov 2001 · Seminars in Cardiothoracic and Vascular Anesthesia
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