Hülya SUNGURTEKİN, Ercan GÜRSES, Ali Vefa ÖZCAN, Fahri ADALI, Ahmet BALTALARLI, Gökhan ÖNEM, Mustafa SAÇAR

Proksimal aort cerrahisinde sağ aksiller arter kanülasyonu güvenilir bir yöntemdir

Amaç: Günümüzde, kardiyopulmoner bypassta standart periferik arteriyel kanülasyon yeri ana femoral arterdir. Bununla birlikte, proksimal aort cerrahisinde çıkan aort kanülasyona uygun olmadığı zaman aksiller arter kanülasyonu kullanılabilir. Bu çalışmada, aksiller arter kanülasyonu uygulanan olgular değerlendirildi. Çalışma planı: Çalışmaya sağ aksiller arter kanülasyonu uygulanan 14 hasta (6 kadın, 8 erkek; ort. yaş 60; dağılım 41-77) alındı. Endikasyonlar çıkan aort anevrizması (n=8), tip A aort diseksiyonu (n=5) ve aort darlığı (n=1) idi. Dört hasta daha önce kalp ameliyatı geçirmişti. En sık uygulanan cerrahi işlemler, yedi olguda suprakoroner çıkan torasik aort replasmanı ve iki olguda aort kapak replasmanı ve çıkan torasik aort replasmanı idi. Bir olguda aksiller arter direkt olarak kanüle edilirken, diğerlerinde aksiller artere prostetik Dacron greft anastomoze edildi. On üç olguda hipotermik sirkülatuvar arrest ve aksiller arter yoluyla antegrad serebral perfüzyon uygulandı.Bulgular: Ameliyat sonrası dönemde üç olguda (%21.4) mortalite görüldü; bir olgu kanama, iki olgu multiorgan yetmezliği nedeniyle kaybedildi. Aksiller arter arteriyel akımı tüm olgularda yeterliydi. Kanülasyona bağlı mortalite, inme, brakiyal pleksus yaralanması, aksiller arter trombozu ve enfeksiyon gibi komplikasyonlara rastlanmadı.Sonuç: Kardiyopulmoner bypassta aksiller arter kanülasyonu, aort diseksiyonu, çıkan aort anevrizması, kalsifik aort ve tekrar ameliyatları gibi çeşitli kardiyak cerrahi girişimlerde kolay, güvenli ve etkin bir yöntem olarak görünmektedir.

Cannulation of the right axillary artery is a safe method in proximal aortic surgery

Background: Currently, the standard peripheral arterial cannulation site is the common femoral artery in cardiopulmonary bypass. However, the axillary artery can be used when the ascending aorta is not suitable for cannulation in proximal aortic surgery. We evaluated patients in whom cannulation was performed through the axillary artery. Methods: The study included 14 patients (6 women, 8 men; mean age 60 years; range 41 to 77 years) who underwent right axillary artery cannulation. Indications were ascending aortic aneurysm (n=8), type A aortic dissection (n=5), and aortic stenosis (n=1). Four patients had a previous cardiac surgery. The most frequent surgical procedures were supracoronary ascending thoracic aorta (ATA) replacement in seven patients, and aortic valve replacement and ATA replacement in two patients. The axillary artery was cannulated directly in one patient and with a prosthetic Dacron graft in the other patients. Antegrade cerebral perfusion via the axillary artery was used under hypothermic circulatory arrest in 13 patients.Results: Postoperative mortality occurred in three patients (21.4%). Two patients died from multiorgan failure, and one patient died from bleeding. Arterial flow in the axillary artery was sufficient in all patients. There were no cannulation-related complications including mortality, stroke, brachial plexus injury, axillary artery thrombosis, or infection.Conclusion: Axillary artery cannulation for cardiopulmonary bypass seems to be an easy, safe, and effective procedure in a variety of cardiac surgical procedures such as aortic dissections, ascending aortic aneurysms, calcified aorta, and reoperations

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