Regesta Tommaso, Cavozza Corrado, Campanella Antonio, Pellegrino Pasquale, Gherli Riccardo, Maj Giulia, Audo Andrea
Department of Cardiac Surgery, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
JTCVS Tech. 2021 Apr 27;8:1-6. doi: 10.1016/j.xjtc.2021.04.017. eCollection 2021 Aug.
To evaluate outcomes of single sternum access for right subclavian artery cannulation without infraclavicular incision in surgery of the thoracic aorta.
Between January 2015 and December 2019, 44 consecutive patients underwent surgery of the thoracic aorta with cannulation of the right subclavian artery, after sternotomy and before pericardiotomy, through a direct percutaneous cannula with a single access without additional infraclavicular skin incision. The indication for surgery was type A acute aortic dissection in 29 patients (65.9%), proximal aortic aneurysm in 11 (25%), and aneurysm of the aortic arch in 4 (9%). Operative procedures were replacement of the ascending aorta in 23 patients, Bentall procedure in 10, hemiarch replacement in 6, and total arch replacement in 5. The mean cardiopulmonary bypass (CPB) and cross-clamp times were 185 ± 62 minutes and 138 ± 41 minutes, respectively.
The in-hospital mortality rate was 6.8%. Permanent neurologic dysfunction occurred in 3 patients (6.8%) and temporary neurologic dysfunction occurred in 4 patients (9.0%). There were no vascular complications related to this technique. No lesions to the vagus and recurrent laryngeal nerves have been reported.
In our experience, a single sternum access for right subclavian artery cannulation avoids the risk and complications of an infraclavicular incision required for axillary artery cannulation. This technique is safe and represent a valid option for CBP and antegrade cerebral perfusion during surgery of the thoracic aorta.
评估在胸主动脉手术中，不做锁骨下切口，经单一胸骨入路进行右锁骨下动脉插管的效果。
2015年1月至2019年12月期间，44例连续患者在开胸术后、心包切开术前，通过直接经皮插管经单一入路进行右锁骨下动脉插管，未做额外的锁骨下皮肤切口，接受胸主动脉手术。手术适应证为29例（65.9%）A型急性主动脉夹层、11例（25%）升主动脉近端动脉瘤和4例（9%）主动脉弓动脉瘤。手术方式为23例行升主动脉置换术、10例行Bentall手术、6例行半弓置换术、5例行全弓置换术。平均体外循环（CPB）时间和主动脉阻断时间分别为185±62分钟和138±41分钟。
住院死亡率为6.8%。3例患者（6.8%）发生永久性神经功能障碍，4例患者（9.0%）发生暂时性神经功能障碍。未出现与该技术相关的血管并发症。未报告迷走神经和喉返神经损伤。
根据我们的经验，经单一胸骨入路进行右锁骨下动脉插管可避免腋动脉插管所需锁骨下切口的风险和并发症。该技术安全，是胸主动脉手术中CPB和顺行性脑灌注的有效选择。
