Mehmet YILMAZ, İ.Yücesin ARSLAN, Fuat BİLGEN, İ.Oral HASTAOĞLU, Umut AYOĞLU, Onur SOKULLU, Fikri YAPICI, Soner SANİOĞLU

Çıkan aort ve arkus aorta cerrahisinde aksiller arter kanülasyonu

Amaç: Aksiller arter kanülasyonu ile kanülasyonla ilişkili ateroembolik olaylar azalmakta, kardiyopulmoner bypass sırasında malperfüzyon daha az görülmekte ve antegrad beyin perfüzyonu daha kolay yapılabilmektedir. Bu nedenle, son yıllarda femoral arter kanülasyonuna tercih edilmektedir. Bu çalışmada aksiller arter kanülasyonu kullanılarak çıkan aort veya arkus aorta cerrahisi uygulanan ilk 30 hastaya ait sonuçlar değerlendirildi. Çalışma planı: Çalışmaya, açık uçlu düz femoral kanül kullanılarak direkt aksiller arter kanülasyonu uygulanan ardışık 30 hasta (20 erkek, 10 kadın; ort. yaş 59; dağılım 36-74) alındı. Ameliyat endikasyonları, 14 hastada çıkan aort anevrizması, 12’sinde akut tip A aort diseksiyonu, ikisinde arkus aorta anevrizması, birinde aortik intramural hematom, birinde çıkan aort, arkus aorta ve inen aort anevrizması idi.Bulgular: Hastaların tümünde aksiller arter kanülasyonu başarıyla uygulandı. Hiçbir hastada kalıcı pleksus hasarı görülmezken, bir hastada (%3.3) aksiller arter hasarı gelişti. Kardiyopulmoner bypass sırasında hiçbir hastada malperfüzyon görülmedi. Yirmi beş hastada ortalama 36±19 dakika sürdürülen hipotermik sirkülatuvar arrest uygulandı. Hastane mortalitesi üç olguda (%10) görüldü. İki hastada (%6.7) kalıcı inme, iki hastada da geçici nörolojik hasar saptandı.Sonuç: Aksiller arter kanülasyonu kolay ve güvenli bir yöntemdir. Antegrad beyin perfüzyonunu kolaylaştırarak geçici nörolojik disfonksiyonları azaltır, diseksiyon tamirinde malperfüzyon görülme olasılığını düşürür ve lokal yara sorunları yok denecek kadar azdır. Bu nedenle, çıkan aortun kanülasyon için uygun olmadığı durumlarda tercih edilmelidir.

Axillary artery cannulation in surgery of the ascending aorta and the aortic arch

Background: Axillary artery cannulation allows easy implantation of antegrade cerebral perfusion while reducing cannulation- related atheroembolic events or false lumen perfusion during cardiopulmonary bypass. For this reason, it has been preferred to femoral cannulation in recent years. This study aimed to evaluate the results of axillary artery cannulation in first 30 patients operated on for pathologies of the ascending aorta or the aortic arch. Methods: The study included 30 consecutive patients (20 males, 10 females; mean age 59 years; range 36 to 74 years) who underwent direct axillary cannulation using an open-end straight femoral cannula. Indications for surgery included aneurysm of the ascending aorta (n=14), acute type A aortic dissection (n=12), aneurysm of the aortic arch (n=2), aortic intramural hematoma (n=1), and aneurysms of the ascending aorta, aortic arch, and descending aorta (n=1).Results: Axillary artery cannulation was successful in all the patients. Permanent brachial plexus injury did not occur. Axillary artery dissection occurred in only one patient (3.3%). Malperfusion was not observed during cardiopulmonary bypass. Twenty-five patients required hypothermic circulatory arrest with a mean duration of 36±19 minutes. Inhospital mortality was seen in three patients (10%). Permanent stroke occurred in two patients (6.7%) and transient neurologic dysfunction occurred in two patients.Conclusion: Axillary artery cannulation is easy and safe. It decreases the rate of transient neurologic dysfunction by allowing easy implantation of the antegrade cerebral perfusion and decreases possibility of malperfusion during repair of the dissection, and is associated with very rare local wound problems. Therefore, it should be preferred in cases in which the ascending aorta is not suitable for cannulation.

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