Publication Date

12-1-2014

Journal

The Texas Heart Journal

DOI

10.14503/THIJ-13-3947

PMID

25593522

Publication Date(s)

December 2014

Language

English

PMCID

PMC4251329

PubMedCentral® Posted Date

12-1-2014

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Aneurysm, dissecting/surgery; aortic aneurysm, thoracic/surgery; brachiocephalic trunk; brain/blood supply; cannulation; cardiopulmonary bypass; catheterization/methods; circulatory arrest, deep hypothermic induced; heart arrest, induced; perfusion/methods; postoperative complications/prevention & control

Abstract

The brachiocephalic artery is an alternative cannulation site in the repair of ascending aortic lesions that require circulatory arrest. We evaluate the effectiveness and safety of this technique.

Proximal aortic surgery was performed in 32 patients from 2006 through 2012 via brachiocephalic artery cannulation and circulatory arrest. Twenty-four (75%) of the patients were men. The mean age was 48.69 ± 9.43 years (range, 30–68 yr). Twelve had type I dissection, 2 had type II dissection, and 18 had true aneurysms of the ascending aorta. All operations were performed through a median sternotomy. The arterial cannula was inserted through an 8-mm vascular graft anastomosed to the brachiocephalic artery in an end-to-side fashion. In dissections, the distal anastomosis was performed without clamping the aorta. The patients were cooled to 24 °C, and circulatory arrest was established. The brachiocephalic and left carotid arteries were clamped, and antegrade cerebral perfusion was started at a rate of 10 mL/kg/min. Cardiopulmonary bypass was resumed after completion of the distal anastomosis and the initiation of rewarming. The proximal anastomosis was then performed.

None of the patients sustained a major neurologic deficit, but 5 patients experienced transient postoperative agitation (<24 >hr). There were 2 early deaths (6.25%), on the 3rd and the 11th postoperative days, both unrelated to the cannulation technique.

Brachiocephalic artery cannulation through a graft can be a safe and effective technique in proximal aortic surgical procedures that require circulatory arrest.

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