Urbanski P P, Lenos A, Lindemann Y, Zacher M, Frank S, Diegeler A
Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Thorac Cardiovasc Surg. 2010 Aug;58(5):276-9. doi: 10.1055/s-0029-1240979. Epub 2010 Aug 2.
Cannulation of arch arteries (innominate, axillary or carotid) for arterial return during cardiopulmonary bypass is increasingly being used; however, the flow and pressure profile in the cannulated arteries remains unclear. The aim of this study was to evaluate the flow and pressure characteristics of arterial inflow through a carotid artery, especially with regard to operative and technical aspects, clinical outcomes, and side-related differences.
Between January 2005 and April 2008, 200 consecutive patients underwent elective aortic arch surgery at our facility. One hundred patients were assigned to undergo cannulation of the left and another 100 to undergo cannulation of the right carotid artery. Both groups were similar in terms of age, sex, and type of surgery. In all patients, arterial return was through a side-graft anastomosed to the carotid artery. The arterial line was also used for unilateral cerebral perfusion for brain protection during mild hypothermic circulatory arrest. The flow and pressure profiles in the arterial line and in the carotid artery were evaluated with regard to cardiopulmonary bypass flow rate and side of cannulation.
No complications related to the cannulation of a carotid artery were observed. The arterial return was adequate in all patients, regardless of the side being cannulated. Because of low resistance (mean pressure<50 mmHg) in the carotid artery proximal to the inflow side-graft, the flow toward the aortic arch averaged 87+/-2% (range 84.4-92%) of the total flow volume (4.6+/-0.5 L/min), without a significant difference between the sides. However, the perfusion pressure in the arterial line was significantly higher when the left carotid artery was cannulated (216+/-30 mmHg vs. 205+/-30 mmHg; P=0.013). There was also a significant difference in the pressure in the distal carotid arteries, which, compared to the systolic blood pressure prior to cardiopulmonary bypass, increased by 30+/-24 mmHg on the left and decreased by 16+/-21 mmHg on the right (P<0.001).
Both common carotid arteries are suitable for arterial cannulation; however, left-sided cannulation is associated with an increase in the pressure profile. Therefore, if vascular pathology does not dictate cannulation of the left carotid artery, the right carotid artery should be considered the site of choice.
在体外循环期间，用于动脉回血的主动脉弓动脉（无名动脉、腋动脉或颈动脉）插管越来越多地被采用；然而，插管动脉中的血流和压力分布仍不清楚。本研究的目的是评估通过颈动脉的动脉流入的血流和压力特征，特别是在手术和技术方面、临床结果以及与侧别相关的差异。
2005年1月至2008年4月期间，200例连续患者在我们的机构接受了择期主动脉弓手术。100例患者被分配接受左颈动脉插管，另外100例接受右颈动脉插管。两组在年龄、性别和手术类型方面相似。在所有患者中，动脉回血通过与颈动脉吻合的侧支移植物进行。动脉管路也用于在轻度低温循环停搏期间进行单侧脑灌注以保护大脑。根据体外循环流速和插管侧别评估动脉管路和颈动脉中的血流和压力分布。
未观察到与颈动脉插管相关的并发症。无论插管侧别如何，所有患者的动脉回血均充足。由于流入侧支移植物近端的颈动脉阻力较低（平均压力<50 mmHg），流向主动脉弓的血流平均占总血流量（4.6±0.5 L/min）的87±2%（范围84.4 - 92%），两侧之间无显著差异。然而，当左颈动脉插管时，动脉管路中的灌注压力显著更高（216±30 mmHg对205±30 mmHg；P = 0.013）。远端颈动脉的压力也存在显著差异，与体外循环前的收缩压相比，左侧升高30±24 mmHg，右侧降低16±21 mmHg（P<0.001）。
双侧颈总动脉均适合动脉插管；然而，左侧插管与压力分布增加有关。因此，如果血管病变不要求插管左颈动脉，则应考虑右颈动脉作为首选部位。
