RESUMO
OBJECTIVE: To demonstrate a novel, reproducible, and effective method of direct innominate artery cannulation using a 14 F pediatric venous cannula to establish antegrade cerebral protection (ACP) in patients undergoing aortic surgery that requires an open distal anastomosis or hemiarch replacement. METHODS: We reviewed prospectively gathered data on all patients who had undergone replacement of the ascending aorta or hemiarch with an open distal anastomosis using deep hypothermic circulatory arrest and direct innominate artery cannulation with a 14 F pediatric venous cannula at our institution. After central cannulation and cooling to 25 °C to 28 °C, all patients had ACP initiated by way of a direct innominate cannula placed over a guidewire. RESULTS: Fifty patients underwent direct innominate artery cannulation with our technique from 2010 to 2012. The operative mortality was 2% (n = 1), and the rates of neurologic morbidity were acceptable and similar to those with other methods of ACP delivery: stroke (2%, n = 1), seizure (0%, n = 0), and delirium (18%, n = 9). The mean operative time was 31 ± 9, 19 ± 5, 100 ± 39, 141 ± 39, and 259 ± 63 minutes for cooling, circulatory arrest, crossclamp, cardiopulmonary bypass, and total operative time, respectively. No local or arterial complications were observed. CONCLUSIONS: Direct cannulation of the innominate artery using a 14 F pediatric venous cannula is a simple, reproducible, safe, and effective technique for establishing ACP in patients undergoing aortic surgery that requires an open distal anastomosis or hemiarch replacement. This technique avoids the additional time and potential local complications associated with other established methods for delivering ACP, such as axillary cannulation.
Assuntos
Aorta Torácica/cirurgia , Implante de Prótese Vascular , Tronco Braquiocefálico , Cateterismo/métodos , Circulação Cerebrovascular , Parada Circulatória Induzida por Hipotermia Profunda , Perfusão/métodos , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/mortalidade , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Parada Circulatória Induzida por Hipotermia Profunda/mortalidade , Desenho de Equipamento , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Perfusão/efeitos adversos , Perfusão/instrumentação , Perfusão/mortalidade , Complicações Pós-Operatórias/mortalidade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Dispositivos de Acesso VascularRESUMO
In this report we present a 43-year-old male with achondroplastic dwarfism who presented with acute Type A aortic dissection with aortic insufficiency. The patient underwent successful Bentall and hemiarch repair. Anesthetic, perfusion-related, and surgical planning and execution are presented.
