The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 3 , Pages 797-798, March 2010

Reply to the Editor

Division of Cardiothoracic Surgery, Columbia University, New York, NY

Article Outline

CTSNet classification: 26.1.3, 26.1.4

 

We have read the article by Dr Küçüker and his colleagues with great interest. They should be congratulated on their excellent clinical outcome of arch repair using right brachial artery cannulation.1 Their technique achieves the same goal as the axillary artery cannulation technique. Although the brachial artery might be easier to access, its size might occasionally prevent it from being used. Monitoring of the antegrade selective perfusion pressure, which we believe to be a critical component of assessment of the cerebral perfusion, might be easier with axillary cannulation with an arterial pressure line placed in the right radial artery. Also, axillary artery cannulation itself is not very complicated and is usually done within 30 minutes. Therefore, we still prefer using the axillary artery as a cannulation site.

Dr Küçüker and his colleagues have suggested an excellent and very important point: that surgeons should be aware of those patients whose aortic dissection extends into those arteries or whose right axillary artery takes off aberrantly from the descending aorta. Careful review of preoperative imaging will reliably identify an aberrant artery and extension of dissection into the innominate artery. A dissected axillary artery should be apparent at the time of direct examination. If the artery is dissected, we agree that alternative cannulation is required. A well performed side graft anastomosis should not lead to a pressurized false lumen, even if the arch is dissected. Careful clamping of the innominate artery, after examination of the vessel, will prevent clamping off of the true lumen.

Since the publication of the article, our aortic surgery practice has continued to expand. The axillary artery cannulation technique remains a reproducible and reliable method of arterial outflow in our hands as well as others2, 3, 4 and will continue to be our choice. However, it is crucially important to be aware of the pitfalls suggested by Dr. Küçüker and others and to use judicious clinical judgment for each case for its safe and successful use.1, 5

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References 

  1. Taşdemir O, Saritaş A, Küçüker S, Ozatik MA, Sener E. Aortic arch repair with right brachial artery perfusion. Ann Thorac Surg. 2002;73:1837–1842
  2. Halkos ME, Kerendi F, Myung R, Kilgo P, Puskas JD, Chen EP. Selective antegrade cerebral perfusion via right axillary artery cannulation reduces morbidity and mortality after proximal aortic surgery. J Thorac Cardiovasc Surg. 2009;138:1081–1089
  3. Etz CD, Plestis KA, Kari FA, Silovitz D, Bodian CA, Spielvogel D, et al. Axillary cannulation significantly improves survival and neurologic outcome after atherosclerotic aneurysm repair of the aortic root and ascending aorta. Ann Thorac Surg. 2008;86:441–446
  4. Svensson LG, Blackstone EH, Rajeswaran J, Sabik JF, Lytle BW, Gonzalez-Stawinski G, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk?. Ann Thorac Surg. 2004;78:1274–1284
  5. Orihashi K, Sueda T, Okada K, Takahashi S. Compressed true lumen in the innominate artery: a pitfall of right axillary arterial perfusion in acute aortic dissection. J Thorac Cardiovasc Surg. 2009;137:242–243

PII: S0022-5223(09)01391-9

doi:10.1016/j.jtcvs.2009.10.026

Refers to article:

  • Brachial artery cannulation

    Seref A. Kucuker, Oguz Tasdemir
    The Journal of Thoracic and Cardiovascular Surgery December 2003 (Vol. 126, Issue 6, Pages 2106-2107)

  • Safety of axillary artery cannulation

    Aslihan Kucuker, Erol Sener
    The Journal of Thoracic and Cardiovascular Surgery March 2010 (Vol. 139, Issue 3, Page 797)

The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 3 , Pages 797-798, March 2010

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