title: Axillary artery cannulation provides balanced cerebral oxygenation.
abstract: Deterioration of cerebral performance remains a major problem after cardiac surgery. Axillary artery cannulation can improve clinical outcome, but some experimental series show a malperfusion of the right hemisphere. The aim of our clinical study was to analyze the intraoperative investigation of cerebral oxygenation in two different arterial cannulation sites by use of near-infrared spectroscopic oximetry (NIRO). We compared retrospectively the cerebral saturation of 20 patients with aortic cannulation (group AoC) and 20 patients with right axillary artery cannulation (group AxC) during either valve, coronary artery bypass graft (CABG), combined procedures, or aortic surgery. Patients were monitored with bihemispheric NIRO (NIRO-200, Hamamatsu, Herrsching, Germany). The oxygenation data were calculated as tissue oxygenation index (TOI). And the cardiopulmonary bypass time was considered with special regard to potentially dangerous phases for cerebral desaturation like the starting of the extracorporeal circulation (ECC), cross-clamping, rewarming phase, aortic declamping, and stopping of ECC. Patients were then postoperatively evaluated by a standardized neurological examination. During the entire CPB time and the specific phases potentially at risk for cerebral desaturation, no statistically significant drop of cerebral oxygenation (>20 % for >60 s) was detected after aortic and right axillary artery cannulation, respectively. Furthermore, no significant difference in TOI was found comparing the left and right hemisphere in each group. Postoperatively 2 transient confusional syndromes (CS) were observed after aortic and 3 CS after axillary artery cannulation. Right axillary artery cannulation provides balanced cerebral oxygenation in both hemispheres during extracorporeal circulation and its specific phases potentially at risk for cerebral malperfusion. It might therefore reduce the risk of neurological injury by reduction of solid embolization and maintenance of balanced cerebral oxygenation.
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital of the Westfaelische Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, D-48159, Muenster, Germany. juliahillebrand@yahoo.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Hillebrand
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Ploss
authors.affiliation: Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital of the Westfaelische Wilhelms-University Muenster, Albert-Schweitzer-Campus 1, D-48159, Muenster, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Martens
mesh_terms: D000368:Aged; D001011:Aorta; D001366:Axillary Artery; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D009460:Neurologic Examination; D010100:Oxygen / Q000097:blood*; D012189:Retrospective Studies; D012307:Risk Factors; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: Axillary artery cannulation; Cerebral oxygenation; Extracorporeal circulation; Neuroprotection; Vascular access