RESUMO
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in patients undergoing mitral valve surgery, does atrial incision affect early postoperative rates of atrial arrhythmia'. Two hundred and four papers were found. Nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Data suggest that a transeptal incision is associated with increased rates of postoperative atrial arrhythmia compared with direct left atriotomy.
RESUMO
OBJECTIVES: Axillary artery cannulation has been used as an alternative site for cardiopulmonary bypass during surgery for aortic dissections and aneurysmal disease of the ascending aorta and arch. This study reports our experience with reusing the axillary artery for cardiopulmonary bypass during complex aortic and cardiac surgical procedures. METHODS: This was a retrospective review of a single surgeon's experience of recannulating the axillary artery for redo operations in complex aortic surgery. Seven patients over a 7-year period have undergone recannulation of their axillary arteries. The old Dacron graft stump was either excised and a new graft was anastamosed to the axillary artery or a new end-to-side anastamosis was performed either proximal or distal to the original graft stump. RESULTS: There were no deaths, strokes, or postoperative complications. In one patient, axillary cannulation was aborted intraoperatively due to high-line pressures, suggesting a local dissection. The other patients all had adequate perfusion via the recannulated axillary artery and there were no complications associated with its reuse. CONCLUSIONS: Recannulation of the axillary artery is easily achievable and should be considered in redo aortic and complex cardiac surgery.
