Brachial artery perfusion for redo ascending and aortic arch cases
Turkiye Klinikleri Journal of Medical Sciences, cilt.29, sa.5, ss.1116-1123, 2009 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 29 Sayı: 5
- Basım Tarihi: 2009
- Dergi Adı: Turkiye Klinikleri Journal of Medical Sciences
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.1116-1123
- Anahtar Kelimeler: Aorta, brain ischemia, brachial artery, reoperation
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: Ascending and/or aortic arch complications identified during the follow-up of previous cardiac surgery dictate urgent reoperation. The role of brachial artery cannulation in such cases was evaluated with regard to its potential benefits. Material and Methods: Between January 2000 and December 2007, 50 patients (34 male/16 female; mean age: 50.1 ± 13.5; range: 22-70) underwent repeat cardiac surgery for ascending/aortic arch repair using this technique. The previous surgical procedures were predominantly aortic valve operations. The average interval between the initial cardiac operation and the reoperation was 101 ± 80 months (1-324 months). The complications leading to repeat cardiac surgery were aneurysm formation and/or rupture in ascending/aortic arch in 28 patients, Stanford type-A dissection in 20 patients and pseudo aneurysm development in 2 patients. Results: Hospital mortality was 10% (5 patients), mainly due to uncontrollable bleeding and low cardiac output. The average cardiopulmonary bypass and aortic cross-clamp times were 144 ± 59 (70-335) and 93 ± 25 (53-156) minutes, respectively. The average low flow antegrade cerebral perfusion (via right brachial artery) period was 29 ± 11.6 minutes (range: 16-78 minutes) under moderate (26-30°C) hypothermia. No neurological complication or organ dysfunction was observed in the early or late postoperative periods. Comprehensive neurocognitive function assessments revealed no postoperative deterioration. The average amount of chest tube drainage was 942 ± 133 (550-1300) mL. All survivors (45 patients, 90%) were discharged within 5-16 days postoperatively and were in good condition at their last follow-up visits. Conclusion: Perfusion via brachial artery cannulation is a safe and reliable approach in reoperations for ascending and aortic arch complications. Copyright © 2009 by Türkiye Klinikleri.