Chow, md max kanevsky, md goals and mechanics of cardiopulmonary bypass the cardiopulmonary bypass cpb circuit is designed to perform four major functions. Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli nasim hedayati, md j. Boot camp cardiac faculty john alexander, md brian bethea, md. In addition, the success and relative ease of peripheral cannulation, among other technological advances, has permitted the. Direct axillary cannulation for cardiopulmonary bypass. It provides potential benefits such as antegrade perfusion of the aorta, low risk of false lumen perfusion in aortic dissection, and the possibility of antegrade cerebral perfusion during aortic arch repair. We report a case where we established safe cardiopulmonary bypass with common carotid artery cannulation in an adult patient. The depth from the skin to the axillary artery surrounding the thoracoacromial artery zone 1, and the thicknesses of pectoralis major zone 2 and pectoralis minor zone 3 were measured by computed tomography before surgery, at 1 and. Axillary artery has been proposed as alternative for arterial cannulation in surgical procedures involving the thoracic aorta 1,2. Usefulness of the axillary artery as vascular access for.
Pectoral muscle atrophy after axillary artery cannulation. In this paper we report our clinical experience with extended utilization of axillary artery cannulation for cardiopulmonary bypass cpb and discuss the indi. Axillary artery cannulation was increasingly used for cardiopulmonary bypass, especially in acute aortic dissection type a. Cannulation of the axillary artery for cardiopulmonary bypass. 1 oxygenation and carbon dioxide elimination, 2 circulation of blood, 3 systemic. Axillary artery cannulation for cardiopulmonary bypass. The most preferred arterial cannulation region during cardiopulmonary bypass is ascending aorta. Axillary artery cannulation with a dacron graft for. In cardiovascular practice today, the axillary artery is one of the best alternative cannulation sites in acute type a aortic dissection. Axillary artery cannulation for cardiopulmonary bypass has been described previously as a safe and reliable technique, with a low risk of atheroemboli, avoidance of malperfusion in aortic dissection and facilitation of selective antegrade cerebral perfusion during hypothermic circulatory arrest. Advantages of such an approach include antegrade flow during cardiopulmonary bypass cpb and a monohemispherical brain perfusion, in case of circulatory arrest, without additional selective cannulation. They also show their approach for reoperative axillary artery cannulation and discuss potential complications and pitfalls.
How to cannulate the aorta for cardiopulmonary bypass. After undraping, petechial and subcutaneous hemorrhage with blister formations were found in right upper extremity. Additional approaches for cannulation, aortic occlusion, and myocardial protection. Choosing an ideal cannulation site, employing peri and intraoperative imaging, selecting an appropriate cannula, and avoiding complications are vital to success. Aortic cannulation for cardiopulmonary bypass cpb is linked to cerebral microemboli emanating from the ascending aorta. Cardiac surgery simulation curriculum simulationbased training in surgical skills and decision making richard h. Despite of axillary artery cannulation being technically more difficult than the aorta or the femoral artery, it promotes antegrade flow through a vessel usually free from atherosclerotic disease 1. We combined transapical cannulation and right axillary artery cannulation in the repair of acute type a aortic dissection in order to reduce mortality and morbidity in the presence of risk of malperfusion. Axillary artery cannula was considered to compress right subclavian and disturb venous return in the right subclavian. Read axillary artery cannulation for cardiopulmonary bypass during surgery on the ascending aorta and arch, journal of cardiac surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips.
This study reports our experience with reusing the axillary artery for cardiopulmonary bypass during complex aortic and cardiac surgical procedures. Background aortic cannulation for cardiopulmonary bypass cpb is linked to. Liberal use of axillary artery cannulation for aortic and. Cardiopulmonary bypass tsda boot camp july 2528, 20 chapel hill, nc. Cannulation of an atherosclerotic ascending aorta, aortic crossclamping, and the sandblasting effect from a cannula jet can induce formation of an aortic dissection. The senior authors technique will be highlighted and illustrated through an accompanying video, with discussion of helpful methods to avoid common pitfalls. The patient underwent aortic valve replacement for severe aortic regurgitation 8. This is an approximately 15 minute long educational video that is designed for medical students, nursing students, anesthesia residents, or anyone who is new to the cardiac surgery operating room. Aortic calcification or disease requiring replacement precludes aortic cannulation. Performing axillary artery cannulation, during cardiopulmonary bypass in patients with an atherosclerotic ascending aorta or acute dissection of the ascending aorta and arch, is of growing interest.
After undraping, petechial and subcutaneous hemorrhage with blister. Clinical experience with axillary artery cannulation led to the hypothesis that axillary cannulation may be cerebroprotective. However, alternative arterial cannulation regions may be needed in the surgical treatment of. The femoral artery and vein have been the preferred cannulation sites for cardiopulmonary bypass in such cases, although alternative sites such as the axillary arteries, and supraaortic branches have been proposed. Using the femoral artery as aortic return, however, possible complications, for example, cerebral embolization and organ malperfusion, could be caused by a retrograde blood flow. As we previously published 1, the innominate artery cannulation presents many advantages versus axillary artery cannulation.
Using side graft axillary cannulation technique can reduce risk of developing these complications. It describes the basic set up for cardiopulmonary bypass, including a description of the cannulas. Aortic cannulation sutures 2 concentric 20 ethibond stitches with sliders outer suture with two pledgets. Cardiopulmonary bypass pumps are operated by perfusionists. Petechial and subcutaneous hemorrhage with blister. Our aim is to present our experience, to describe the surgical technique, and to demonstrate the sufficient cerebral and total body perfusion through axillary artery cannulation. This is also useful for establishing antegrade cerebral perfusion during concomitant aortic surgery. Cardiopulmonary bypass and the anesthesiologist christina moramangano, md john l. Expanded use of axillary artery cannulation during cardiac operations could decrease the incidence of stroke. To investigate postoperative pectoral atrophy in 141 patients undergoing aortic arch surgery involving bilateral axillary artery cannulations with side grafts. The cpb pump itself is often referred to as a heartlung machine or the pump. Left axillary artery perfusion in surgery of type a aortic dissection. Six patients had acute type a and 2 had chronic type a dissec. Early and midterm results of transapical and right.
Extended utilization of axillary cannulation as arterial access for cardiopulmonary bypass. Page 11 cannulation techniques central cannulation. A basic instructional video outlining the technique i use for aortic cannulation using actual case footage. Deltoidopectoralis approach to axillary vessels for full. Axillary artery cannulation for cardiopulmonary bypass during surgery on the ascending aorta and arch article pdf available in journal of cardiac surgery 243. The ascending aorta is the customary site for arterial cannulation for cardiopulmonary bypass. Cannulation of the axillary artery for cardiopulmonary. Alternative sites for arterial cannulation are the transverse arch of the aorta, the descending aorta, the femoral artery, the iliac artery, and the axillary and subclavian arteries. Favorable experience at our institution and elsewhere using axillary artery cannulation in treating type a aortic dissections has caused us to broaden our indications for using this site for arterial cannulation for cardiopulmonary bypass. Innominate versus axillary artery cannulation for aortic.
Femoral cannulation first alternative to aortic cannulation indicated for initiating cpb quickly in cardiac arrest, acute, dissections, limited access complications retrograde arterial dissection 0. Usefulness of the axillary artery as vascular access for cardiopulmonary bypass p. 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. Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli by nasim hedayati, j. Favorable experience at our institution 1 and elsewhere using axillary artery cannulation in treating type a aortic. A 72yearold man underwent aortic valve replacement and coronary artery bypass graft using cardiopulmonary bypass with right axillary artery cannulation. These, along with the steps to arterial cannulation, are discussed. Open access protocol axillary versus innominate artery. Between october 2009 and march 2012, 23 aortic dissection patients age, 54. Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli. The incidence of aortic dissection after cardiopulmonary bypass has been reported to range from 0. Comparison of ascending aorta versus femoral artery. Cardiac surgery has made significant progress since the advent of cardiopulmonary bypass.
There are certain situations in redo cardiac surgery in adults where it may not be possible to use alternate arterial cannulation sites like the common femoral artery and axillary artery. Recannulation of the axillary artery in aortic and complex. In this present paper we would like to compare the innominate artery cannulation with the axillary artery cannulation during surgery of the aorta for acute and chronic diseases. The femoral artery has been the standard cannulation site for cardiopulmonary bypass in treating acute aortic dissection type a aada. We believe that using a side graft is a preferable cannulation technique for the right axillary artery. The aim of this study is to examine indications and the local and systemic results of axillary artery use as cannulation site for cardiopulmonary bypass. Normal postoperative findings related to cardiopulmonary bypass include a felt pledgets, which are used to reinforce cannulation.
Read arterial pressure monitoring during cardiopulmonary bypass using axillary arterial cannulation, journal of cardiothoracic and vascular anesthesia on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Right axillary artery cannulation in aortic valve replacement. Va ecmo cannulation venous cannula sites drainage rl femoral vein right ij right atrium arterial cannula sites reinfusion rl femoral artery rcca neonates axillary artery aorta. Left axillary artery perfusion in surgery of type a aortic. Unlike most surgeons, i prefer to cannulate the axillary artery directly with a special angled low profile cannula rather than utilizing a chimney graft. Tears, late stenosis, thrombosis, bleeding, lymph fistula, infection in groin, cerebral or coronary.
Side graft axillary artery cannulation in id proximal. The postoperative length of icu stay was 3 172 days in the whole series. Study purpose the purpose of this trial is to compare innominate artery cannulation to axillary artery cannulation as a means of cerebral protection during moderate hypo. Cardiopulmonary bypass cpb is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patients body. Arterial pressure monitoring during cardiopulmonary bypass. Arterial cannulation for bypass is a cornerstone to most cardiac procedures. Axillary artery is considered an alternative cannulation site for cardiopulmonary bypass. Axillary artery cannulation via a side graft allows for safe arterial access avoiding aortic manipulation in aortic valve replacement. Extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes. They focus on the relevant anatomy, surgical preparation, and cannulation technique.
198 1170 63 661 911 1163 1016 253 896 484 990 288 941 667 1370 1022 146 975 482 726 731 1231 603 218 740 368 170 557 1334 20 1368