Wada Shinichi, Yamamoto Shin, Honda Jiro, Hiramoto Akinori, Wada Hideichi, Hosoda Yasuyuki
Aortic Center, Kawasaki Saiwai Hospital, Kawasaki-shi, Kanagawa, Japan.
J Thorac Cardiovasc Surg. 2006 Aug;132(2):369-72. doi: 10.1016/j.jtcvs.2006.04.016.
The femoral artery is the customary site for arterial cannulation for cardiopulmonary bypass in treating type A aortic dissections. However, because of concerns regarding complications caused by retrograde perfusion, the number of surgeons who prefer using the axillary artery as the site for cannulation is increasing. However, axillary artery cannulation also involves some problems. Thus we prefer transapical aortic cannulation for repair of type A aortic dissection.
Transapical aortic cannulation was performed in 138 patients (83 men and 55 women; mean age, 60.1 years; 129 acute and 9 chronic; 120 hemiarch repair and 15 total arch replacement) with type A aortic dissection. A 1-cm incision is made in the apex of the left ventricle, and a 7-mm soft and flexible cannula is passed through the apex and across the aortic valve until positioned in the ascending aorta transesophageal echocardiographic guidance.
There were no cases in which conversion to cannulation of another artery was necessary. In all cases cardiopulmonary bypass flow was sufficient (>2.5 L/m(-2)/min(-1)). There were no malperfusion events. Eight (5.8%) patients had cerebrovascular accidents. Twenty-six (18.8%) patients died in the hospital of complications not related to transapical aortic cannulation.
Our results show that transapical aortic cannulation is safe and useful for repair of type A aortic dissection. There are advantages to transapical aortic cannulation, such as simple and quick cannulation technique, sufficient antegrade aortic flow, and the reliability of true lumen perfusion with decreased risk of stroke and malperfusion.
股动脉是治疗A型主动脉夹层时体外循环动脉插管的常用部位。然而，由于担心逆行灌注引起的并发症，越来越多的外科医生倾向于使用腋动脉作为插管部位。然而，腋动脉插管也存在一些问题。因此，我们更倾向于经心尖主动脉插管来修复A型主动脉夹层。
对138例A型主动脉夹层患者（83例男性和55例女性；平均年龄60.1岁；129例急性和9例慢性；120例半弓修复和15例全弓置换）进行经心尖主动脉插管。在左心室心尖处做一个1厘米的切口，将一根7毫米柔软灵活的插管经心尖穿过主动脉瓣，直至在经食管超声心动图引导下置于升主动脉内。
没有病例需要转换为其他动脉插管。所有病例的体外循环流量均充足（>2.5L/m(-2)/min(-1)）。没有发生灌注不良事件。8例（5.8%）患者发生脑血管意外。26例（18.8%）患者在医院死于与经心尖主动脉插管无关的并发症。
我们的结果表明，经心尖主动脉插管对A型主动脉夹层的修复是安全且有用的。经心尖主动脉插管有诸多优点，如插管技术简单快捷、主动脉顺行血流充足以及真腔灌注可靠，可降低中风和灌注不良的风险。
