Directing a dispersion cannula tip toward the aortic root during thoracic aortic arch surgery does not adversely affect cardiac function

Abstract

Introduction:

Neurologic complications of open thoracic aortic surgery are devastating problems in patients with severely diseased aortas. This study aimed to clarify whether directing the aortic cannula tip toward the aortic root affects the postoperative cardiac function in patients undergoing open thoracic aortic surgery.

Methods:

A total of 16 patients who underwent total or partial arch replacement between January 2014 and April 2019 were enrolled and divided into two groups. Ascending aorta perfusion was performed by placing the cannula tip toward the aortic root (reversed direction group, seven patients) or toward the aortic arch (standard direction group, nine patients). Intraoperative and perioperative data, including mortality, morbidity, and postoperative cardiac function, were compared between the groups.

Results:

There were no hospital deaths or stroke events in either group. The aortic cross-clamping time was 102.4 ± 20.3 minutes in the reversed direction group and 87.1 ± 9.9 minutes in the standard direction group (p = 0.049). Furthermore, the intubation time was 28.4 ± 12.9 hours in the reversed direction group and 12.4 ± 6.8 hours in the standard direction group (p = 0.022). Both times were significantly longer in the reverse direction group. Postoperative serum creatine kinase-MB levels were significantly lower in the reversed direction group (6.2 ± 3.3 U/L vs 13.3 ± 4.8 U/L, respectively, p = 0.006). The cardiac output and cardiac index did not significantly differ.

Conclusions:

Directing the aortic cannula tip toward the aortic root does not adversely affect the postoperative cardiac function after aortic arch surgery.

Keywords

aortic perfusion atheroembolism aortic arch surgery cardiac function cardiopulmonary bypass

Get full access to this article

View all access options for this article.

References

Salazar

Wityk

Grega

, et al. Stroke after cardiac surgery: short- and long-term outcomes. Ann Thorac Surg 2001; 72: 1195–1202.

Wareing

Davila-Roman

Barzilai

, et al. Management of the severely atherosclerotic ascending aorta during cardiac operations. J Thorac Cardiovasc Surg 1992; 103: 453–462.

Imasaka

Tayama

Tomita

The impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery. J Thorac Cardiovasc Surg 2017; 153: 1045–1053.

Okada

Omura

Kano

, et al. Recent advancements of total aortic arch replacement. J Thorac Cardiovasc Surg 2012; 144: 139–145.

Kazui

Yamashita

Washiyama

, et al. Aortic arch replacement using selective cerebral perfusion. Ann Thorac Surg 2007; 83: S796–S798.

Minatoya

Ogino

Matsuda

, et al. Evolving selective cerebral perfusion for aortic arch replacement: high flow rate with moderate hypothermic circulatory arrest. Ann Thorac Surg 2008; 86: 1827–1831.

Thomas

Cook

, et al. Contemporary results of open aortic arch surgery. J Thorac Cardiovasc Surg 2012; 144: 838–844.

Ogino

Sasaki

Minatoya

, et al. Evolving arch surgery using integrated antegrade selective cerebral perfusion: impact of axillary artery perfusion. J Thorac Cardiovasc Surg 2008; 136: 641–648.

Ayyash

Tranquilli

Elefteriades

JA.

Femoral artery cannulation for thoracic aortic surgery: safe under transesophageal echocardiographic control. J Thorac Cardiovasc Surg 2011; 142: 1478–1481.

10.

Shiiya

Yasuda

Murashita

, et al. Transapical aortic cannulation for hypothermic aortic operation through a left thoracotomy: an alternative to avoid retrograde arterial perfusion. J Thorac Cardiovasc Surg 1997; 113: 1113–1114.

11.

Fukuda

Fujimori

Daitoku

, et al. Flow velocity and turbulence in the transverse aorta of a proximally directed aortic cannula: hydrodynamic study in a transparent model. Ann Thorac Surg 2009; 87: 1866–1871.

12.

Yamana

Ito

Maekawa

, et al. Atherosclerotic arch aneurysm operations with perfusion toward the aortic valve. Ann Thorac Surg 2010; 89: 435–439.

13.

Grooters

Thieman

Schneider

, et al. Assessment of perfusion toward the aortic valve. Tex Heart Inst J 2000; 27: 361–365.

14.

Okita

Takamoto

Ando

, et al. Mortality and cerebral outcome in patients who underwent aortic arch operations using deep hypothermic circulatory arrest with retrograde cerebral perfusion: no relation of early death, stroke, and delirium to the duration of circulatory arrest. J Thorac Cardiovasc Surg 1998; 115: 129–138.

15.

Minakawa

Fukuda

Yamazaki

, et al. Effect of cannula shape on aortic wall and flow turbulence: hydrodynamic study during extracorporeal circulation in mock thoracic aorta. Artif Organs 2007; 31: 880–886.

16.

Minakawa

Fukuda

Igarashi

, et al. Hydrodynamics of aortic cannulae during extracorporeal circulation in a mock aortic arch aneurysm model. Artif Organs 2010; 34: 105–112.

17.

Strauch

Spielvogel

Lauten

, et al. Axillary artery cannulation: routine use in ascending aorta and aortic arch replacement. Ann Thorac Surg 2004; 78: 103–108.

18.

Minakawa

Fukuda

Inamura

, et al. Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta. Gen Thorac Cardiovasc Surg 2008; 56: 215–221.

19.

Crooke

Schwartz

Ribakove

, et al. Retrograde arterial perfusion, not incision location, significantly increases the risk of stroke in reoperative mitral valve procedures. Ann Thorac Surg 2010; 89: 723–729.