A simple method to establish antegrade cerebral perfusion during hemiarch reconstructionCentral MessagePerspective
Objective: We describe a novel and safe technique using a 12F–14F pediatric arterial cannula to establish unilateral, selective, antegrade cerebral perfusion (ACP) during open hemiarch reconstruction. Methods: Between January 2015 and September 2018, 42 patients underwent elective aortic aneurysm re...
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Elsevier
2020-06-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250720301607 |
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| author | Stephane Leung Wai Sang, MD Tyler J. Beute, MD, RN Tomasz Timek, MD, PhD |
| author_facet | Stephane Leung Wai Sang, MD Tyler J. Beute, MD, RN Tomasz Timek, MD, PhD |
| author_sort | Stephane Leung Wai Sang, MD |
| collection | DOAJ |
| description | Objective: We describe a novel and safe technique using a 12F–14F pediatric arterial cannula to establish unilateral, selective, antegrade cerebral perfusion (ACP) during open hemiarch reconstruction. Methods: Between January 2015 and September 2018, 42 patients underwent elective aortic aneurysm repair requiring an open distal anastomosis and at least a hemiarch replacement via hypothermic circulatory arrest by 2 surgeons. All distal reconstructions were performed at moderate hypothermia (22°C–26°C) with direct cannulation of the innominate artery (IA) using a pediatric arterial cannula to allow ACP at 10–15 mL/kg/min. Data were collected by retrospective chart review. Results: Thirty-one of the 42 patients (74%) were male. The mean patient age was 65 ± 13 years, and the mean body surface area was 2.1 ± 0.3 m2. Proximal repairs included a modified Bentall with a valve-graft composite (n = 17), valve-sparing root replacement (n = 2), and aortic valve replacement (n = 15). Perioperative mortality was 2% (n = 1), and the incidence of stroke was 0%. The mean lowest core body temperature reached during circulatory arrest was 23.8 ± 2.7°C with a mean ACP time of 21.8 ± 3.6 minutes. The mean aortic cross-clamp and cardiopulmonary bypass times were 160.6 ± 55.5 minutes and 204.7 ± 57.5 minutes, respectively. There were no cases of IA injury. Conclusions: Direct IA cannulation with a pediatric arterial cannula is a safe and efficient method to allow ACP in aortic surgery requiring hypothermic circulatory arrest and may circumvent the potential complications of axillary cannulation. |
| format | Article |
| id | doaj-art-e550455555834695b06dea49844909da |
| institution | DOAJ |
| issn | 2666-2507 |
| language | English |
| publishDate | 2020-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-e550455555834695b06dea49844909da2025-08-20T03:04:58ZengElsevierJTCVS Techniques2666-25072020-06-012101510.1016/j.xjtc.2020.03.012A simple method to establish antegrade cerebral perfusion during hemiarch reconstructionCentral MessagePerspectiveStephane Leung Wai Sang, MD0Tyler J. Beute, MD, RN1Tomasz Timek, MD, PhD2Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich; Address for reprints: Stephane Leung Wai Sang, MD, 100 Michigan St NE Suite 8830, Grand Rapids, MI 49503.Michigan State University College of Human Medicine, Grand Rapids, MichDepartment of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, MichObjective: We describe a novel and safe technique using a 12F–14F pediatric arterial cannula to establish unilateral, selective, antegrade cerebral perfusion (ACP) during open hemiarch reconstruction. Methods: Between January 2015 and September 2018, 42 patients underwent elective aortic aneurysm repair requiring an open distal anastomosis and at least a hemiarch replacement via hypothermic circulatory arrest by 2 surgeons. All distal reconstructions were performed at moderate hypothermia (22°C–26°C) with direct cannulation of the innominate artery (IA) using a pediatric arterial cannula to allow ACP at 10–15 mL/kg/min. Data were collected by retrospective chart review. Results: Thirty-one of the 42 patients (74%) were male. The mean patient age was 65 ± 13 years, and the mean body surface area was 2.1 ± 0.3 m2. Proximal repairs included a modified Bentall with a valve-graft composite (n = 17), valve-sparing root replacement (n = 2), and aortic valve replacement (n = 15). Perioperative mortality was 2% (n = 1), and the incidence of stroke was 0%. The mean lowest core body temperature reached during circulatory arrest was 23.8 ± 2.7°C with a mean ACP time of 21.8 ± 3.6 minutes. The mean aortic cross-clamp and cardiopulmonary bypass times were 160.6 ± 55.5 minutes and 204.7 ± 57.5 minutes, respectively. There were no cases of IA injury. Conclusions: Direct IA cannulation with a pediatric arterial cannula is a safe and efficient method to allow ACP in aortic surgery requiring hypothermic circulatory arrest and may circumvent the potential complications of axillary cannulation.http://www.sciencedirect.com/science/article/pii/S2666250720301607circulatory arrestantegrade cerebral perfusionaortic surgeryinnominate artery |
| spellingShingle | Stephane Leung Wai Sang, MD Tyler J. Beute, MD, RN Tomasz Timek, MD, PhD A simple method to establish antegrade cerebral perfusion during hemiarch reconstructionCentral MessagePerspective JTCVS Techniques circulatory arrest antegrade cerebral perfusion aortic surgery innominate artery |
| title | A simple method to establish antegrade cerebral perfusion during hemiarch reconstructionCentral MessagePerspective |
| title_full | A simple method to establish antegrade cerebral perfusion during hemiarch reconstructionCentral MessagePerspective |
| title_fullStr | A simple method to establish antegrade cerebral perfusion during hemiarch reconstructionCentral MessagePerspective |
| title_full_unstemmed | A simple method to establish antegrade cerebral perfusion during hemiarch reconstructionCentral MessagePerspective |
| title_short | A simple method to establish antegrade cerebral perfusion during hemiarch reconstructionCentral MessagePerspective |
| title_sort | simple method to establish antegrade cerebral perfusion during hemiarch reconstructioncentral messageperspective |
| topic | circulatory arrest antegrade cerebral perfusion aortic surgery innominate artery |
| url | http://www.sciencedirect.com/science/article/pii/S2666250720301607 |
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