Brachiocephalic Artery Cannulation for Patients with Diseased Ascending Aorta

Atsushi Aoki	Tadashi Omoto	Kazuto Maruta
Tomoaki Masuda

（Department of Cardiovascular Surgery, Showa University, Tokyo, Japan）

Objective:The ascending aortic cannulation（Ao-C）is the routine procedure for cardiopulmonary bypass（CPB）in our hospital. However, for patients with diseased ascending aorta, such as severely calcified aorta, dissected or aneurysmal aorta, we used brachiocephalic artery（BCA）cannulation. The effectiveness and simplicity of BCA cannulation was evaluated. Methods:For patients with diseased ascending aorta, BCA was cannulated when the diameter of BCA is larger than 10 mm and is free from calcification, since January 2013. There were 62 patients who underwent aortic valve replacement（AVR）for aortic valve stenosis and BCA cannulation was applied for 11 patients. Standard Ao-C was used for remaining 51 patients. There were 44 patients with dissected or aneurysmal ascending aorta and BCA cannulation was applied for 7 patients, axillary artery perfusion was used for 15 patients and standard Ao-C was used for 22 patients. Consciousness level at the time of awaking from general anesthesia and any complication related with BCA cannulation was evaluated for the effectiveness. Simplicity was evaluated by the time required to establish CPB after skin incision. Results:In AVR patients, there was 1 patient with delayed consciousness level recovery with BCA cannulation and this patient was found to have cerebral infarction by CT. Intraoperative aortic dissection, probably due to BCA cannulation was observed in 1 patient, very old fragile and long period steroid user. In diseased ascending aorta patients, no patient suffered neurological accident nor any complication due to cannulation. In AVR patients, the time required to establish CPB after skin incision was 51＋/－9min in BCA cannulation and 47＋/－10min in Ao-C patients（p＝0.34). In diseased ascending aorta patients, the time required to establish CPB after skin incision was 49＋/－49min in BCA cannulation and 51＋/－16min（p＝0.82). Conclusion:BCA cannulation is a very simple and safe technique to establish CPB for patients with diseased ascending aorta. However great care should be taken, and BCA cannulation should be avoided for the long term steroid users or patients with connective tissue disease.
　　

Jpn. J. Cardiovasc. Surg. 45:211-217（2016）

Keywords：brachiocephalic artery;cardiopulmonary bypass;severely calcified aorta;aortic dissection;ascending aortic aneurysm