İbrahim KARA, Adil POLAT, Kaan KIRALİ, Altuğ TUNCER, Cüneyt KELEŞ, Eylem Yayla TUNCER, Salih AULASALEH, İlker MATARACI, Kamil BOYACIOĞLU

Axillary artery cannulation in ascending aortic pathologies

Amaç: Bu çalışmada kardiyopulmoner bypass (KPB) için aksiller kanülasyonun sonuçları ve mortalite ve morbiditeye etki eden faktörler incelendi. Çalışma planı: Kasım 2006 - Ocak 2009 tarihleri arasında çıkan aort patolojileri nedeniyle ameliyata alınan 84 hasta (58 erkek, 26 kadın; ort. yaş 53.8±13.2 yıl; dağılım 20-77 yıl) aksiller kanülasyonla ameliyat edildi. Toplamda 84 hastaya 124 işlem uygulandı ve en sık uygulanan işlem 64 hastaya (%76.2) yapılan çıkan aort replasmanıydı. En sık ameliyat endikasyonu 51 hastada (%60.7) bulunan çıkan aort anevrizmasıydı. Üç hasta (%3.6) daha önce açık kalp ameliyatı geçirmişti. Hipotermik dolaşım arresti 51 hastada (%60.7) kullanıldı ve aksiller arter 75 hastada (%89.3) doğrudan, dokuz hastada (%10.7) ise bir yan greft aracılığıyla kanüle edildi. Bulgular: Ameliyat sonrasında hastaların üçünde (%3.6) sepsis, ameliyat sırası kanama ve düşük kardiyak debi sendromu nedeniyle hastane mortalitesi meydana geldi. Hastaların 10’unda (%11.9) nörolojik komplikasyonlar görüldü (8’inde geçici nörolojik disfonksiyon ve 2’sinde inme). Ortalama hastanede kalma süresi 5.1±5.6 (dağılım 1-46) gündü. Ameliyat sonrası ortalama takip süresi 10.3±5.5 (dağılım 1-15.5) aydı (toplam 68.5 hasta/yıl). Taburcu sonrası takip sürecinde mortalite görülmedi. Kanülasyon yöntemi ile mortalite ya da nörolojik komplikasyonlar arasında herhangi bir ilişki saptanmadı. Sonuç: Aksiller arter arteriyel kanülasyon için güvenli bir yoldur ve aksiller yol ameliyat sonrası mortalite ve morbiditede artışa neden olmaz.

Çıkan aort patolojilerinde aksiller arter kanülasyonu

Background: We analyzed the results of axillary cannulation for cardiopulmonary bypass (CPB) and the factors affecting mortality and morbidity. Methods: Eighty-four patients (58 males, 26 females; mean age 53.8±13.2 years; range 20 to 77 years) were operated on for ascending aortic pathologies with axillary arterial cannulation between November 2006 and January 2009. Overall, 124 procedures were performed in 84 patients, and the most commonly performed procedure was the replacement of the ascending aorta which was employed in 64 patients (76.2%). The most common indication for operation was ascending aortic aneurysm that was present in 51 patients (60.7%). Three (3.6%) patients had previously undergone open heart surgery. Hypothermic circulatory arrest was used in 51 (60.7%) patients, and the axillary artery was cannulated directly in 75 (89.3%) patients and via a side graft in nine (10.7%) patients. Results: Postoperatively, three patients (3.6%) had in-hospital mortality because of sepsis, intraoperative bleeding, and low cardiac output syndrome. Neurological complications were seen in 10 (11.9%) patients (8 had transient neurological dysfunction and 2 had stroke). The mean duration of hospital stay was 5.1±5.6 (range 1 to 46) days. Postoperative follow-up was 10.3±5.5 (range 1 to 15.5) months on average (total of 68.5 patient/years). There was no mortality during the follow-up after discharge. No relationship was found between the method of cannulation and mortality or, neurological complications. Conclusion: The axillary artery is a safe route for arterial cannulation, and the axillary route does not cause an increase in postoperative mortality and morbidity.

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