Simultaneous selective cerebral perfusion and systemic circulatory arrest through the right axillary artery for aortic surgery.
The duration of safe circulatory arrest for replacement of the ascending aorta for a type A dissection, without additional cerebral perfusion measures, is not clearly defined. If prolonged periods (> 60 minutes) are anticipated, retrograde cerebral perfusion or selective antegrade carotid perfusion may be required. The latter requires separate cannulas with subsequent snaring of the cerebral vessels, which may be time consuming and cumbersome. We propose an alternative method whereby the right axillary artery is cannulated for cardiopulmonary bypass and, when the desired hypothermic temperature is achieved, the flows are turned down to 500 mL/min. The origin of the innominate artery is then occluded establishing selective antegrade right carotid artery perfusion. The distal ascending or aortic arch anastomosis is then performed while the remainder of the body is under selective systemic circulatory arrest. The proximal aortic anastomosis is performed after the graft is clamped proximally and flows return to appropriate perfusion levels.
Byrne
J G
JG
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. jgbyrne@bics.bwh.harvard.edu
Fitzgerald
D J
DJ
Aranki
S F
SF
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001366:Axillary Artery; D019917:Blood Vessel Prosthesis Implantation; D016122:Brachiocephalic Trunk; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D002339:Carotid Arteries / Q000502:physiology; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D012449:Safety; D013997:Time Factors