title: Brachial artery cannulation facilitates lower ministernotomy cardiac surgery.
abstract: BACKGROUND
  Lower ministernotomy has become a more popular approach for many heart operations. However, cannulation of the ascending aorta may cause serious complications. Femoral and brachial arteries have been used for alternative arterial cannulation sites.
  
  
  METHODS
  The lower ministernotomy approach was used in 65 patients. Ascending aortic cannulation was performed in group 1 (n = 38), femoral cannulation in group 2 (n = 12), and brachial cannulation in group 3 (n = 15) patients. Brachial artery diameter was measured preoperatively by Doppler ultrasound in the preoperative period.
  
  
  RESULTS
  Average cross-clamp time for femoral and brachial artery cannulated patients was significantly shorter than in patients in group 1 (31 +/- 9 and 35 +/- 6 minutes, respectively) (p = 0.034). Total cardiopulmonary bypass (CPB) time was 56 +/- 11 minutes for group 1, 39 +/- 7 minutes for group 2, and 41 +/- 5.4 minutes for group 3 (p = 0.041). Operation time was 112 +/- 24, 88 +/- 12, and 91 +/- 11 minutes for the groups 1, 2, and 3, respectively. There was also statistically significant difference between group 1 and group 3 comparisons with regard to CPB time (p = 0.041). Difficult exposure from many cannulas impedes access and lengthens the operation in group I. Superficial wound infection developed in seven patients in group 1, one patient in group 2, and one patient in group 3.
  
  
  CONCLUSIONS
  Cannulation of the brachial artery is superior to the femoral due to possible infection and lymph leakage with the latter and both are superior to central cannulation when lower ministernotomy is performed. By avoiding the difficulties of central aortic cannula placement the operative time is decreased and possible wound edge is protected as lesser exposure is required.
authors.affiliation: Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlik, Ankara, Turkey. udemirkilic@gata.edu.tr
authors.forename: Ufuk
authors.initials: U
authors.lastname: Demirkilic
authors.forename: Erkan
authors.initials: E
authors.lastname: Kuralay
authors.forename: Faruk
authors.initials: F
authors.lastname: Cingoz
authors.forename: Hakan
authors.initials: H
authors.lastname: Bingol
authors.forename: Celalettin
authors.initials: C
authors.lastname: Gunay
authors.forename: Vedat
authors.initials: V
authors.lastname: Yildirim
authors.forename: Selim
authors.initials: S
authors.lastname: Kilic
authors.forename: Harun
authors.initials: H
authors.lastname: Tatar
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000601:surgery; D001916:Brachial Artery / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002404:Catheterization; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D013249:Sternum / Q000601:surgery*; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome