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
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
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.