Carotid Artery Cannulation in Aortic Surgery
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Objective: Carotid artery cannulation (CAC) was initially established at our clinic for surgery of acute aortic dissection and became the standard approach for these procedures in which circulatory arrest is necessary. The aim of the study was to evaluate the usefulness and efficiency of the method in regard to operative and neurological outcomes.
Methods: Between July 2002 and August 2005, 91 consecutive patients underwent aortic surgery using CAC by means of a side graft for arterial return with a mean flow rate of 4.6 ± 0.5 L/min. There were 26 patients (28.6%) with acute dissections and 14 patients (15.4%) had had prior cardiac surgery. In elective patients, extended preoperative diagnostics as well as neuro-monitoring during surgery were aimed for. During circulatory arrest, (mean duration 26 ± 19 min.) the arterial line was used for unilateral cerebral perfusion in moderate hypothermia (mean rectal temperature 28 ± 2°C) with a mean flow rate of 0.8 ± 0.2 L/min.
Results: CAC offered a sufficient arterial return in all patients. In no case was a switch to another cannulation site for arterial return necessary. Furthermore, no complications related to cannulation site were observed. One patient with acute dissection and one with chronic aneurysm died during the early postoperative course. Thus, 30-day mortality was 2.2% for the whole group and 3.8% for the dissection group. Two patients with severe calcification of the aortic valve suffered from stroke (one without residual symptoms). There were no strokes in the dissection group, although in 4 patients signs of cerebral perfusion were presented preoperatively. As compared to transcranial Doppler, which is not always feasible, the measurement of arterial pressure on the radial arteries was observed as a constant parameter for assessment of cerebral flow.
Conclusions:
CAC is a fast, safe and efficient method of arterial cannulation even in very obese patients. In addition, it simplifies the performance of unilateral cerebral perfusion through the arterial line during circulatory arrest, for which an interruption of cerebral perfusion is completely omitted.
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