Goeboeloes, Laszlo and Ugocsai, Peter and Foltan, Maik and Philipp, Alois and Thrum, Andrea and Miskolczi, Szabolcs and Malvindi, Pietro G. and di Gregorio, Vincenzo and Pousios, Dimitrios and Navaratnarajah, Manoraj and Ohri, Sunil K. (2014) Central Cannulation by Seldinger Technique: A Reliable Method in Type A Aortic Dissection Repairs. MEDICAL SCIENCE MONITOR, 20. pp. 2386-2393. ISSN 1643-3750,
Full text not available from this repository. (Request a copy)Abstract
Background: Extensive type A aortic dissections that involve peripheral great vessels can complicate the choice of a cannulation site for cardiopulmonary bypass. We started to employ direct cannulation of the true lumen on the concavity of the aortic arch by Seldinger technique and evaluated the efficacy of this access technique as an alternative arterial inflow target in aortic surgery. Material/Methods: Twenty-four consecutive patients (mean age: 59 +/- 14 years) underwent type A aortic dissection repair using selective antegrade cerebral perfusion. Direct aortic cannulation was used in 14 cases, subclavian access in 6 patients, and femoral entry in 4 patients. Perioperative factors were evaluated to identify the reliability and eventual benefits of direct cannulation method at the aortic arch. Results: There were no operative deaths and cumulative 30-day mortality rate was 25% (6). Permanent neurological deficits were not observed; in 1 patient transient changes occurred (4%). Time to reach circulatory arrest was the shortest in the direct access group, with mean 27 +/- 11 (CI: 20.6-33.3) min vs. 43 +/- 22 (28.0-78.0) min (p=0.058) and 32 +/- 8 (23.6-40.4) min (p=0.34) by femoral cannulation and subclavian entry, respectively. Direct arch cannulation resulted in the best renal function in the first 72 h after surgery and similar characteristics were observed in lactic acid levels. Conclusions: Ultrasound-guided direct cannulation on the concavity of the aortic arch using a Seldinger technique is a reliable method in dissection repairs. Prompt antegrade perfusion provides not only cerebral but also peripheral organ and tissue protection, which is an advantage in this high-risk group of patients.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | AXILLARY ARTERY CANNULATION; HYPOTHERMIC CIRCULATORY ARREST; SELECTIVE CEREBRAL PERFUSION; ASCENDING AORTA; CARDIOPULMONARY BYPASS; FEMORAL CANNULATION; ARCH SURGERY; MODERATE; SAFE; PROTECTION; Aortic Aneurysm; Aortic Diseases; Hemodynamics; Tissue Preservation |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie Medicine > Lehrstuhl für Klinische Chemie und Laboratoriumsmedizin |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 08 Aug 2019 07:14 |
| Last Modified: | 08 Aug 2019 07:14 |
| URI: | https://pred.uni-regensburg.de/id/eprint/9191 |
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