Ahmet DOLAOĞLU, EYÜP AVCI, Onursal BUĞRA

Cannulation of Innominate Artery during Proximal Aortic Aneurysm Repair

Objective: There are many debates for cannulation sites during aortic surgeries. The cannulation technique which is providing antegrade flow is associated with better survival and neurological outcomes than retrograde flow. For this purpose, innominate and axillary artery cannulation have been increasingly used for cardiopulmonary bypass recently. We aimed to present our experience with innominate artery cannulation for cardiopulmonary bypass and antegrade selective cerebral perfusion during proximal aortic aneurysm repair. Methods: A total of eighteen patients with proximal aortic aneurysm underwent surgical repair were included into the study. Pre-operative patient’s charecteristis, surgical details and postoperative outcomes were investigated. Results: The mean age was 58.8±10.2 and majority of the patients were male (72%). Bicuspit leafletes was found in 9 patients (50%). Two patients died in postoperative period. No stroke or new neurological deficit was seen after procedures. Conclusions: This study is emphasize that cannulation of innominate artery can be used in safe and effective during aortic surgery.

Proximal Aort Cerrahisinde Innominate arter kanülasyonu

Giriş: Aort cerrahisi uygulamalarında kardiyopulmoner bypass için arteryel kanülasyon bölgesi hala tartışma konusudur. Son yıllarda antegrade akım sağlayan kanülasyon tekniklerinin retrograde akım sağlayan bölgelere göre sağ kalım ve nörolojik sonuçlar açısından daha faydalı olduğunun gözlenmesi üzerine innominate arter ve axiller arter kullanımını artırmıştır. Bu çalışmada aort cerrahisinde innominate arter kanülasyonu üzerine olan tecrübelerimizi paylaşmayı amaçladık. Yöntemler: Çalışmaya proximal aort cerrahisi nedeniyle cerrahi tamir yapılan 18 hasta dahil edilmiştir. Hastaların preoperatif , operatif özellikleri ve post-operatif sonuçlar değerlendirilmiştir. Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşları 58.8±10.2 iken hastaların çoğunluğunu erkekler oluşturmaktaydı (%72). Eşlik eden bicuspit art kapak patolojisi 9 hastada bulundu (%50). Postoperatif mortalite iki iken hiçbir hastada cerrahi sonrası inme veya nörolojik defisit gelişmemiştir. Sonuçlar: Çalışma sonrasında aort cerrahisinde kardiyopulmoner bypass için innominate arter kullanımının güvenli ve etkili olduğunu savunmaktayız.

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Ren Z, Wang Z, Hu R, et al. Which cannulation (axillary cannulation or femoral cannulation) is better for acute type A aortic dissection repair? A meta-analysis of clinical studies. Eur J Cardiothorac Surg. 2015; 47: 408–15.

Patris V, Toufektzian L, Field M, et al. Is axillary superior to femoral artery cannulation for acute type A aortic dissection surgery? Interact Cardiovasc Thorac Surg. 2015; 21: 515–20.

Wong DR, Coselli JS, Palmero L, et al. Axillary artery cannulation in surgery for acute or subacute ascending aortic dissections. Ann Thorac Surg. 2010; 90: 731–7.

Uchino G, Yunoki K, Sakoda N, et al. Innominate artery cannulation for arterial perfusion during aortic arch surgery. J Card Surg. 2017; 32: 110–3.

Martino A, Re FD, Blasi S, et al. Surgical treatment of annuloaortic ectasia-replace or repair ? Aorta (Stamford). 2017; 5: 139-47.

Preventza O, Garcia A, Tuluca A, et al. Innominate artery cannulation for proximal aortic surgery: outcomes and neurological events in 263 patients. Eur J Cardiothorac Surg. 2015; 48: 937-42.

Kaul P. How I do it-sole innominate cannulation for acute type A aortic dissection. J Cardiothorac Surg. 2012; 7: 125.

Murakami T, Hosono M, Shibata T. Tips and avoid complications related to direct cannulation of the axillary artery. Asian Cardiovasc Thorac Ann. 2018; 26: 250–1.

Hu Z, Wang Z, Ren Z, et al. Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion combined with deep hypothermia circulatory arrest in aortic arch surgery:a metaanalyzis and systemic review of 5060 patients. J Thorac Cardiovasc Surg. 2014; 148: 544–60.

Foley LS, Yamanaka K, Reece TB. Arterial cannulation and cerebral perfusion strategies for aortic arch operations. Semin Cardiothorac Vasc Anesth. 2016; 20: 298–302.