Mycotic Disruption of Aortic Cannulation Site

Two cases of successful repair of leaking mycotic false aneurysms of the ascending aorta from the aortic cannulation site, secondary to mediastinal infection following open heart surgery are described. Institution of cardiopulmonary bypass via the femoral vessels, rapid sternotomy, and fingertip control of the aortic hemorrhage permitted primary repair of the disruption.     

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Objective: Early and mid-term result of transapical aortic (TAA) cannulation technique was evaluated compared with femoral artery (FA) cannulation in Acute Type A Aortic Dissection(AAAD).Methods: From January 2000 to October 2013, 80 consecutive patients with AAAD were underwent the ascending aortic replacement at Nagasaki Kouseikai Hospital. These patients were divided into two groups according to the cannulation site, FA cannulation (n = 34) and TAA cannulation (n = 46). Early and mid-term outcomes were compared between two groups.Result: Preoperative patient characteristics were almost comparable between groups. The time from skin incision to starting cardiopulmonary bypass (CPB) was significantly shorter in the TAA group (45 ± 16 vs 23 ± 5.1 min; P <0.001). There were no significant differences in post-operative cerebral infarction in two groups (17% versus 11%; P = NS). The operative mortality rate was 8.8% in FA group and 4.3% in TAA group (P = NS). During follow up (mean, 6.8 years), survival at 3 years and 5 years was 77.4% and 71.9% in TAA group and 76.3% and 73.8% in FA group, respectively.Conclusion: The postoperative morbidity and mortality between the two groups were almost the same. TAA cannulation for acute Type A aortic dissection is faster, easy and safe with acceptable early and mid-term outcome.     

Experimental Fluid Dynamics of Transventricular Apical Aortic Cannulation

To clarify the flow pattern from a transventricular apical aortic cannula, hydrodynamic analysis of transventricular apical aortic cannulation (apical cannulation) was performed using particle‐image velocimetry in a glass aortic model. Simulated apical cannulation using a 7‐mm Sarns Soft‐Flow cannula and the newly developed 7‐mm apical aortic cannula was compared with standard aortic cannulation. The flow‐velocity, streamline, and distribution of magnitude of the strain rate tensor (function of shear stress) were analyzed. Streamline analysis revealed a steady and organized flow profile in apical cannulation as compared with that in standard aortic cannulation. The magnitude of the strain rate tensor decreased within a few centimeters from the exit of the apical cannula.     

Arterial Cannulation and Myocardial Protection in Severe Diffuse Aortic Calcification

A patient with diffuse and severe aortic calcification is described. The patient had a double vessel coronary disease and it was impossible to cannulate the ascending aorta or the femoral arteries for the cardiopulmonary bypass. Arterial cannulation was performed in the innominate artery and both mammary arteries were used during a short period of ventricular fibrillation.     

经人工血管右腋动脉插管在升主动脉和弓部手术中的应用

目的介绍经人工血管右侧腋动脉插管进行体外循环和选择性顺行性脑灌注的方法。方法共30例患者经右侧腋动脉体外循环，其中累及主动脉弓部的急性StanfordA型夹层动脉瘤23例，合并弓部扩张的升主动脉瘤7例。在右侧锁骨中点下方做长约4～5cm切口，游离腋动脉而不游离臂丛神经和腋静脉，将直径8ram的人工血管与之端侧吻合并与动脉管连接。腋动脉插管用于体外循环，也用于选择性顺行性脑灌注。涉及主动脉弓部手术30例，其中采用经腋动脉顺行性脑灌注行全主动脉弓置换15例，深低温停循环下置换右半弓15例。体外循环结束时直接将人工血管结扎即可。结果患者全部康复出院，经腋动脉插管灌注流量和压力与经升主动脉插管无差异。术后无神经系统并发症发生，右上肢血压正常，未发生动脉损伤、栓塞以及上肢感觉、运动障碍等。结论经人工血管右侧腋动脉插管进行体外循环和选择性脑灌注，操作简单，安全可靠。