title: Extrathoracic cannulation of the left common carotid artery in thoracic aorta operations through a left thoracotomy: preliminary experience in 26 patients.
abstract: BACKGROUND
  In aortic operations performed through a left thoracotomy, which require total bypass and deep hypothermic circulatory arrest, femoral artery cannulation is commonly used for arterial perfusion. This route limits the time of safe circulatory arrest and is associated with the risks of retrograde embolization or, in the case of aortic dissection, malperfusion of the vital organs. To overcome these problems, we have used cannulation of the extrathoracic left common carotid artery to ensure a central a route of arterial perfusion in these operations. The preliminary results are presented.
  
  
  METHODS
  Between December 1999 and April 2001, we used left common carotid artery cannulation in 26 operations on the thoracic aorta performed through a posterolateral thoracotomy with an open technique during deep hypothermic circulatory arrest. Institutional review board approval and informed consent were obtained. The indications included perforating atherosclerotic ulcer (n = 5), chronic aortic aneurysm (n = 9), acute type B aortic dissection (n = 3), and chronic dissection of the thoracic aorta (n = 9). Transcranial Doppler ultrasonographic monitoring of both the right and left middle cerebral arteries was used to assess the adequacy of cerebral bihemispheric perfusion and to determine the differences in blood flow velocities throughout the procedure.
  
  
  RESULTS
  Left common carotid artery cannulation was successful in all patients. All patients awoke from the operation, and none had cerebrovascular accidents. None died in the hospital, and complications related to carotid artery cannulation were not observed. None of the patients experienced postoperative paraplegia. In all patients transcranial Doppler monitoring indicated the absence of cerebral embolic phenomena throughout the entire procedure. Significant differences in middle cerebral artery flow velocities were observed at different phases of the procedures and between the right and left middle cerebral arteries during carotid cannulation and during selective cerebral perfusion. Nevertheless, the maximal drop of right middle cerebral artery blood velocity during selective perfusion through the left common carotid artery was within 50% of the left middle cerebral artery velocity, indicating adequate bihemispheric perfusion.
  
  
  CONCLUSIONS
  In patients undergoing aortic operations through a left thoracotomy, extrathoracic left common carotid artery cannulation was a safe and effective means of providing proximal arterial inflow during cardiopulmonary bypass, which can be used to selectively perfuse the brain, as well as to prevent embolic phenomena in the arch vessels.
authors.affiliation: Istitutos di Chirurgia Cardiovascolare, Unita' Operativa di Chirurgia dell' Aorta Toracica, Metodi Quantitativi, and Neurofisiopatologia, Universita' agli Studi di Siena, Siena, Italy. euxneri@tin.it
authors.forename: Eugenio
authors.initials: E
authors.lastname: Neri
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
authors.forename: Lucio
authors.initials: L
authors.lastname: Barabesi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pula
authors.forename: Rossana
authors.initials: R
authors.lastname: Tassi
authors.forename: Thomas
authors.initials: T
authors.lastname: Toscano
authors.forename: Enrico
authors.initials: E
authors.lastname: Tucci
authors.forename: Antonio
authors.initials: A
authors.lastname: Benvenuti
authors.forename: Gianni
authors.initials: G
authors.lastname: Capannini
authors.forename: Fabio
authors.initials: F
authors.lastname: Miraldi
authors.forename: Carlo
authors.initials: C
authors.lastname: Sassi
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D002545:Brain Ischemia / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000401:mortality; D017536:Carotid Artery, Common; D002404:Catheterization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011184:Postoperative Period; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome