雷米芬太尼后处理对心肺转流诱导犬心肌损伤和炎症因子的影响

目的 探讨雷米芬太尼后处理对心肺转流(CPB)诱导犬心肌损伤和炎症因子的影响.方法 健康成年雄性犬12只,随机均分为雷米芬太尼组(R组)和对照组(C组).两组动物经麻醉和开胸后,建立CPB心肌缺血-再灌注模型,阻断升主动脉60 min.R组于主动脉阻断55 min时自主动脉根部随温血灌注液持续输注雷米芬太尼5 min,速度为4μg·kg-1·min-1,灌注液输注速率2 ml·kg-1·min-1持续5 min.C组于相同时点行温血再灌注,灌注液输注速率同R组.分别于CPB前5 min(T0)、阻断升主动脉后30 min(T1)、开放升主动脉后5 min(T2)、停CPB 30 min(T3)和停CPB 2 h(T4)采集股动脉血,检测心肌肌钙蛋白I(cTnI)的浓度和血浆肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、IL-8.记录主动脉开放后心脏自动复跳情况,电镜下观察心肌组织超微结构改变.结果 与T0时比较,两组cTnI、TNF-α在CPB后各时点均明显升高(P＜0.05或P＜0.01),升主动脉开放后各时点IL-6、IL-8均明显升高(P＜0.01).R组升主动脉开放后各时点cTnI、TNF-α、IL-6、IL-8均明显低于C组(P＜0.01).R组心肌组织结构损伤程度轻于C组.结论 雷米芬太尼后处理可抑制犬CPB诱导促炎细胞因子的释放,减轻心肌再灌注损伤.     

经股动、静脉插管建立体外循环行电视胸腔镜与心内直视手术138例

目的总结采用股动、静脉插管建立体外循环(CPB)技术应用于电视胸腔镜心脏手术和某些心内直视手术的临床经验。方法采用右股动脉插供血管,右股静脉和/或上腔静脉插引流管建立CPB,在电视胸腔镜下行房间隔缺损(A SD)修补术46例,室间隔缺损(V SD)修补术58例,电视胸腔镜辅助下加小切口行二尖瓣置换术29例,心脏不停跳下直视肺动脉瓣狭窄矫治术5例。结果所有患者无死亡,灌注流量1.6~2.4L/m in.m2,平均1.9L/m in.m2;灌注压50~80mmHg(1 kPa=7.5mmHg),平均56mmHg;CPB时间8~157m in,升主动脉阻断时间18~65m in。2例患者于术后出现右下肢局部麻木、疼痛,均于7d后消失,未发生其它与周围CPB有关的并发症。结论股动、静脉插管建立CPB技术可应用于电视胸腔镜心脏手术和某些有适应证的心脏手术患者,其风险小、安全、简便、省时,有临床应用价值。     

盐酸戊乙奎醚对深低温停循环全弓置换术微循环的影响

目的探讨盐酸戊乙奎醚对深低温停循环全弓置换术微循环的影响。方法选择全麻下30例深低温停循环(DHCA)选择性脑灌注行Bentall+全弓置换术患者,随机均分为两组,盐酸戊乙奎醚组(P组)和对照组(C组),P组在右锁骨下动脉完成插管后予盐酸戊乙奎醚3mg,恢复全身CPB后再给予盐酸戊乙奎醚3mg,C组予以等量生理盐水;于麻醉诱导后(T0)、中心体温(食管温)降至22°时(T1)、降主动脉远端开放即刻(T2)、降主动脉远端开放30min(T3)、CPB 3h(T4)、关胸后(T5)分别取动脉血测乳酸值、取静脉血测静脉血氧饱和度(SvO2),并记录相应时间点尿量、血管活性药物用量。结果 P组T2~T5时乳酸明显低于C组(P0.05),T2~T5时SvO2明显高于C组(P0.05),T2~T5时尿量明显多于C组(P0.05)。结论盐酸戊乙奎醚对深低温停循环全弓置换术似有改善微循环水平的作用。     

瑞芬太尼后处理对犬心肺转流后心肌缺血-再灌注损伤的影响

目的研究瑞芬太尼后处理对心肺转流(CPB)犬缺血-再灌注心肌的保护作用及机制。方法 18只成年雄性犬,随机均分为缺血-再灌注组(C组)、缺血后处理组(I组)和瑞芬太尼后处理组(R组)。建立犬CPB模型,阻断升主动脉血流60min。主动脉阻断55min时自主动脉根部进行温血再灌注;I组在开放主动脉之前给予开放30s/再阻断30s三个循环;R组随温血输注瑞芬太尼4μg·kg-1·min-1,持续5min。测定CPB前5min(T0)、开放升主动脉5min(T1)、停CPB30min(T2)和120min(T3)时血浆肌钙蛋白I(cTnI)、丙二醛(MDA)浓度和超氧化物歧化酶(SOD)活性,停CPB120min后测定心肌含水率并观察心肌组织超微结构改变。结果与T0时比较,T1～T3时三组血浆cTnI和MDA浓度均明显升高(P<0.01),而SOD活性明显降低(P<0.01)。T1～T3时I组和R组cTnI和MDA浓度均低于C组(P<0.01),SOD活性高于C组(P<0.01)。I组和R组心肌含水率和超微结构改变均低于或轻于C组(P<0.01),I组和R组各指标差异无统计学意义。结论瑞芬太尼后处理减轻犬CPB后心肌缺血-再灌注损伤,其机制可能与减少活性氧生成并增加SOD活性进而减轻氧化应激有关。     

吡那地尔预处理对体外循环犬心肌的保护效果

目的 探讨ATP敏感性钾通道开放剂(KCOs)吡那地尔(Pinacidil)药物预处理对常温及低温犬体外循环(CPB)晶体高钾停搏液间断灌注心肌的保护效果。方法 18条犬随机分为三组,每组6条,分别建立犬的常温及低温CPB全心缺血Pinacidil预处理模型。对照组(A组):低温CPB,主动脉根部灌注4℃St.Thomas停搏液(K~+16mmol/L)10ml/kg,阻断30min复灌一次(1/2首量);B组:常温CPB,主动脉根部灌注37℃含氧Pinacidil液(0.083mg/kg);C组:低温CPB,主动脉根部灌注液同B组。三组心脏均接受60min缺血和30min再灌注。阻断主动脉前,开放后15min、30min测血液动力学改变;并循环5min,阻断循环30min、60min及开放循环20min于左心室取心肌组织,测定心肌腺苷酸含量。结果 再灌注期间C组的血液动力学指标明显好于A、B组(P<0.01),而B组又较A组好(P<0.01)。缺血及再灌注期间C组心肌的ATP含量也明显高于A、B组(P<0.01),B组又高于A组(P<0.01)。结论 Pinacidil预处理时对CPB下缺血心肌具有良好的保护效果,低温的效果优于常温。     

股动、静脉插管体外循环在电视胸腔镜心脏手术中的应用

目的探讨股动脉、股静脉插管建立体外循环在电视胸腔镜辅助心脏手术中的应用和体外循环的管理。方法85例患者中被诊断为房间隔缺损38例、室间隔缺损43例、二尖瓣狭窄伴关闭不全4例,均经股动脉、股静脉插管建立体外循环,借助电视胸腔镜施行房间隔缺损修补术、室间隔缺损修补术和二尖瓣置换术。结果85例患者体外循环时间30~179min(91.7±27.4min),升主动脉阻断时间6~103min(37.2±6.1min);开放升主动脉后心脏均自动复跳。1例患者因残余漏再次手术,2例患者股动脉拔管时出现血管内膜撕裂;其余82例患者手术过程顺利。85例患者术后均恢复良好,顺利出院。结论股动、静脉插管建立体外循环借助电视胸腔镜施行心脏手术安全、可行。     

全胸腔镜下二尖瓣置换术麻醉体会

目的探讨全胸腔镜下二尖瓣置换术的麻醉心得。方法回顾性分析2011年10月至2012年7月四川大学华西医院拟在全胸腔镜下行二尖瓣置换术7例患者的临床资料。男4例、女3例,年龄19~53(34.17±5.58)岁,体重42~69(56.00±3.69)kg。心功能根据纽约心脏协会(NYHA)分级为Ⅱ~Ⅲ级,术前心电图显示均为窦性心律,超声心动图检查提示,以二尖瓣狭窄病变为主3例,以二尖瓣反流病变为主4例。采用双腔气管内插管,静脉吸入复合全身麻醉,麻醉维持以异丙酚4~10 mg(/kg·h)静脉输注,间断给予舒芬太尼和维库溴铵维持镇痛肌松。在食管超声引导下采用右侧股动静脉插管建立体外循环,主动脉阻断后行主动脉根部顺行性灌注心肌保护液。结果 7例患者中有6例在全胸腔镜辅助下顺利完成二尖瓣置换术,1例中转开胸完成二尖瓣置换术。6例行全胸腔镜下二尖瓣置换术患者主动脉阻断时间71~144(112.33±9.90)min,体外循环(CPB)时间97~180(150.33±11.60)min,手术时间200~300(251.67±13.52)min,术后拔管时间8.0~20.5(14.37±2.06)h,住ICU时间42.5~53.2(47.65±1.42)h,住院时间11~16(14.17±0.79)d。术后均无二尖瓣机械瓣瓣周漏,无血肿、感染、肺不张等严重并发症,无死亡。结论对于电视胸腔镜下二尖瓣手术的麻醉,充分的术前评估和麻醉前准备是基础,术中充足的大脑灌注和静脉引流是重点,经食管超声心动图的指导作用是关键。     

全胸腔镜下微创二尖瓣置换术

目的 总结全胸腔镜下二尖瓣置换手术55例成功经验.方法 采用右胸壁打孔,股动脉、股静脉插管建立周围体外循环,阻闭升主动脉,冷血停跳液顺行灌注保护心肌,全胸腔镜下行二尖瓣置换手术.结果 手术均获成功,无死亡.手术3.6～5.6 h,平均(4.6±1.0)h.体外循环90～146 min,平均(118±28) min,升主动脉阻断55～85 min,平均(70±15) min;术后呼吸机辅助9.2～16.4 h,平均(10.2±3.1) h;胸液引流量80～350 ml,平均(72±28) ml;住院10～16 d,平均(13±3) d.结论 全胸腔镜下二尖瓣置换手术安全可靠、创伤小、恢复快、美容效果好.     

大鼠体外循环心肌胰岛素抵抗实验模型的建立

目的构建大鼠体外循环(CPB)心肌缺血再灌注损伤(MIRI)实验模型并评估其诱导心肌胰岛素抵抗(IR)的效果。方法12只雄性SD大鼠采用随机数字表法分为两组,对照组不阻断主动脉(n=6),模型组主动脉阻断30 min再灌注15 min(n=6);经尾动脉置入灌注管、右侧颈外静脉插入右心房引流管、开胸阻断升主动脉,建立体外循环(CPB),于开放主动脉后15 min采集血液及心肌组织标本,检测血浆葡萄糖、胰岛素水平并进一步计算葡萄糖摄取率、胰岛素抵抗指数(IRI)的变化。采用蛋白质印迹法(Western blot)、免疫荧光检测心肌细胞膜葡萄糖转运蛋白4(GLUT4)的表达。组间比较采用独立样本t检验。结果缺血再灌注后15 min,模型组[静脉葡萄糖浓度(Glu-V)(20.23±0.30)mmol/L;胰岛素浓度(15.89±1.72)mIU/L;IRI(14.29±1.59)]高于对照组[Glu-V(8.31±0.67)mmol/L;胰岛素浓度(6.54±1.77)mIU/L;IRI(2.42±0.73),t=38.945、9.286、16.593,P值均<0.01],差异有统计学意义。而模型组葡萄糖摄取率为(7.68±2.29)%低于对照组[(45.46±3.67)%,t=21.410,P<0.01],差异有统计学意义。模型组左心室收缩压(LVSP)为(34.8±6.6)mmHg低于对照组LVSP[(60.4±6.9)mmHg,t=-6.586,P<0.01],差异有统计学意义。模型组Western blot所测心肌细胞膜蛋白相对表达量为(0.30±0.08)低于对照组(1.04±0.21,t=7.979,P<0.01),差异有统计学意义。结论成功建立操作简便、经济适用、个体差异小且更能模拟临床的CPB缺血再灌注心肌IR大鼠模型。     

去白细胞血再灌注液对体外循环犬心肌缺血再灌注损伤的影响

目的探讨去白细胞血再灌注液对体外循环(CPB)犬心肌缺血再灌注损伤的影响及其机制。方法成年健康犬12条,根据再灌注液成分不同随机分为对照组(C组)和去白细胞血组(D组),每组6条。两组动物经麻醉和开胸后,建立CPB心肌缺血再灌注模型,阻断升主动脉60 min。于阻断40min时,自主动脉根部以2 ml·min-1·kg-1灌入常温晶体液或去白细胞血,持续20 min。分别于阻断前、阻断后30min及60min和开放后30min及60min取静脉血,检测血浆TNF-α、IL-1β、IL-6、IL-8浓度。并于阻断前、阻断后60 min和开放后60 min分别取心肌组织检测髓过氧化物酶(MPO)活性。结果与阻断前比较,阻断后各时点两组TNF-α、IL-1β和IL-8血浆浓度均升高,IL-6血浆浓度在开放后各时点升高(P<0．05);D组开放升主动脉后各时点TNF-α、IL-1β、IL-6和IL-8血浆浓度低于C组(P< 0．01);D组阻断后60 min和开放后60 min MPO活性低于C组(P<0．01)。结论去白细胞血再灌注液能减轻体外循环犬的心肌缺血再灌注损伤,抑制促炎性细胞因子可能是其作用机制之一。     

Management of juxtarenal aortic aneurysms and occlusive disease with preferential suprarenal clamping via a midline transperitoneal incision: technique and results

Surgical management of juxtarenal aortic (JR-Ao) aneurysms and occlusive disease may include supraceliac aortic clamping, a retroperitoneal approach, or medial visceral rotation. The authors report their results using preferential direct suprarenal aortic clamping via a midline transperitoneal incision. Between July 1, 1992, and July 31, 2001, they treated 58 patients with JR-Ao disease (44 aneurysmal, 14 occlusive) via a midline incision without medial visceral rotation. Preferential suprarenal aortic clamping was used in 53 cases (42 proximal to both renal arteries, 11 proximal to the left renal artery only) and supraceliac or supramesenteric clamping in 5 cases when there was insufficient space for an aortic clamp between the superior mesenteric artery and renal arteries. This strategy avoided mesenteric ischemia associated with supraceliac clamping in the majority of cases and afforded better exposure of the right renal artery than obtainable with a left retroperitoneal approach or medial visceral rotation. Eleven patients underwent concomitant renal revascularization. Critical adjuncts included the following: (1) selective left renal vein (LRV) division if the vein stump pressure was < 35 mm Hg (suggesting sufficient renal venous collaterals existed), (2) bilateral renal artery occlusion during aortic clamping to prevent thromboembolism, (3) flushing of aortic debris before restoring renal perfusion, and (4) routine administration of perioperative intravenous mannitol and renal-dose dopamine. Patients with type IV thoracoabdominal aneurysms, ruptured aneurysms, or JR-Ao disease approached via a retroperitoneal incision (severely obese patients, re-do aortic surgery) were excluded. No patients died or required dialysis during their hospital stay. The LRV was divided in 12 (21%) cases and reanastomosed in 2 cases (elevated stump pressures). The average suprarenal clamp time was 26 minutes (range, 10-60). Postoperative serum creatinine remained > 0.5 ng/dL above baseline in 3 (5%) patients. These results support suprarenal aortic clamping with a midline transperitoneal incision as the optimal strategy for treating juxtarenal aortic aneurysms and occlusive disease. The authors believe that selective left renal vein division enhances juxtarenal aortic exposure, and routine administration of renal protective agents, along with occlusion of both renal arteries during suprarenal aortic clamping, are critical adjuncts in performing these operations.     

6%羟乙基淀粉130/0.4体外循环预充对心脏手术患儿血浆胶体渗透压及乳酸水平的影响

Objective To investigate the effects of hydroxyethyl starch 130/0.4 (HES) used as priming fluid for cardiopulmonary bypass (CPB) on the plasma colloid osmotic pressure (COP) and lactic acid (LAC) concentration in infants undergoing cardiac surgery.Methods Forty infants of either sex with age ≤6 yr undergoing cardiac surgery with CPB were randomly divided into 2 groups (n =20 each): HES group and control group. The left radial artery and the right internal jugular vein were cannulated for blood pressure (BP) and the central venous pressure (CVP) monitoring. Arterial blood gases, blood LAC concentration, hemoglobin (Hb), hematocrit (Hct), mean arterial pressure (MAP) and nasopharyngeal temperature were measured and recorded immediately before and 5 min after aortic cross-clamping, at the end of CPB and operation. Plasma COP was measured before induction of anesthesia (T1), at 5 and 30 min of CPB (T2 and T3, respectively), before routine ultra-filtration (T4), at the end of CPB (T5) and2 h in ICU (T6).Results The plasma LAC concentration was significantly lower and the COP significantly higher in HES group than in control group (P＜0.05 or 0.01).The plasma LAC concentration increased after aortic cross-clamping, reached the peak at the end of CPB and then declined at the end of operation, but was still higher than that before aortic cross-clamping in both groups. Plasma COP was significantly decreased during CPB as compared with the baseline at T1, but increased at T6 in both groups.Conclusion Using HES 130/0.4 as pdming fluid for CPB can effectively improve plasma COP and reduce blood LAC level in infants undergoing cardiac surgery with CPB.     

含抑肽酶低温灌注液减轻体外循环肺损伤

目的;研究体外循环期间低温保护液肺动脉灌注对肺脏的保护作用。方法;１２只杂种犬随机均分为２组。主动脉阻断后,对照组右肺动脉灌注４℃乳酸林格液,实验组灌注４℃肺保护液。开放主动脉后和停ＣＰＢ后５,３０,６０,９０分钟;分别取各组肺静脉血标本行生化分析,测定肺功能,并行组织学检查。     

Hemodynamic and hormonal responses to hypothermic and normothermic cardiopulmonary bypass.

Normothermic cardiopulmonary bypass (CPB) is used in cardiac surgery at some institutions. To compare hemodynamic and hormonal responses to hypothermic (29 degrees C) and normothermic nonpulsatile CPB, 20 adults undergoing coronary artery bypass graft and/or aortic valve replacement were studied. Hemodynamic measurements and plasma hormone concentrations were obtained from preinduction to the third postoperative hour. The two groups were given similar amounts of anesthetics and vasodilators. Systemic vascular resistance increased only during hypothermic CPB, and heart rate was higher at the end of hypothermic CPB. Postoperative central venous pressure and pulmonary capillary wedge pressure were lower after hypothermic CPB. Oxygen consumption decreased by 45% during hypothermic CPB, did not change during normothermic CPB, but increased similarly in the two groups after surgery; mixed venous oxygen saturation (SvO2) was significantly lower during normothermic CPB. Urine output and composition were similar in the two groups. In both groups, plasma epinephrine, norepinephrine, renin activity, and arginine vasopressin concentrations increased during and after CPB. However, epinephrine, norepinephrine, and dopamine were 200%, 202%, and 165% higher during normothermic CPB than during hypothermic CPB, respectively. Dopamine and prolactin increased significantly during normothermic but not hypothermic CPB. Atrial natriuretic peptide increased at the end of CPB and total thyroxine decreased during and after CPB, with no difference between groups. This study suggests that higher systemic vascular resistance during hypothermic CPB is not caused by hormonal changes, but might be caused by other factors such as greater blood viscosity. A higher perfusion index during normothermic CPB might have allowed higher SvO2.     

Cardiopulmonary bypass does not alter canine enflurane requirements.

This study determined the effect of cardiopulmonary bypass (CPB) on canine enflurane minimum alveolar concentration (MAC). Fourteen dogs were anesthetized with enflurane in N2O and O2, and after tracheal intubation, the N2O was discontinued. Femoral arterial and pulmonary arterial catheters were placed, and MAC was determined with the tail-clamp method. CPB was initiated via the femoral artery-vein route, with additional venous return obtained from an external jugular vein. Partial CPB was used in the first 10 dogs. In 4 dogs, a membrane oxygenator (group 1) was used, and in the next 6 dogs a bubble oxygenator (group 2) was used. In 4 additional dogs (group 3), using bubble oxygenators, total CPB was achieved by occlusion of the pulmonary artery via a left thoracotomy. The CPB circuit was primed with Ringer's lactate, and circuit blood flows were 70-125 ml.kg-1.min-1, with mean arterial pressures maintained at 50-110 mmHg. MAC was determined again after termination of CPB. In 10 dogs, MAC was also measured during CPB. In 5 dogs MAC was measured after administration of protamine. MAC in all 14 dogs did not change (2.2 +/- 0.3 vs. 2.3 +/- 0.3). MAC remained constant in group 1 (2.4 +/- 0.3 vs. 2.3 +/- 0.4), group 2 (2.2 +/- 0.2 vs. 2.3 +/- 0.3), and group 3 (2.2 +/- 0.1 vs. 2.3 +/- 0.1). Similarly, MAC was unchanged during CPB (2.2 +/- 0.2 vs. 2.2 +/- 0.2) and after protamine (2.3 +/- 0.2 vs. 2.2 +/- 0.3). Temperature was 38.3 +/- 1.2 prebypass and 37.9 +/- 0.9 postbypass.(ABSTRACT TRUNCATED AT 250 WORDS)     

Femoral artery pressures are more reliable than radial artery pressures on initiation of cardiopulmonary bypass

OBJECTIVE: To compare radial and femoral artery perfusion pressure during initiation and various stages of cardiopulmonary bypass (CPB). DESIGN: Prospective study. SETTING: The cardiac center of a tertiary referral teaching institute. PARTICIPANTS: Sixty consecutive patients of all ages undergoing a variety of cardiac operations. INTERVENTIONS: Radial and femoral arterial pressures were measured in all patients on the same transducer, from the beginning to end of CPB. MEASUREMENTS AND MAIN RESULTS: Mean perfusion pressures on CPB measured at the femoral artery at 1, 5, 10, and 15 minutes of CPB were 38.4+/-3.6, 46.2+/-3.1, 49.7+/-3.9, and 52.8+/-4.1 mmHg and were significantly greater than the corresponding radial artery pressures (29.9+/-4.1, 35.3+/-6.1, 40.9+/-4.8, and 41.8+/-5.3 mmHg) (p < 0.001). At 30 minutes and 60 minutes of CPB, femoral artery pressures are higher (60.3+/-8.8 mmHg and 66.4+/-8.2 mmHg) compared with radial artery pressures (54.7+/-6.9 mmHg and 59.6+/-6.1 mmHg), but the difference is less significant (p < 0.05). On conclusion of CPB, mean femoral artery pressures (70.9+/-6.7 mmHg) are greater than mean radial artery pressures (67.6+/-8.1 mmHg) (NS). CONCLUSIONS: Although radial artery pressures are more commonly monitored during cardiac surgery, femoral artery perfusion pressures are more reliable during the initial part of CPB, and routine monitoring of femoral artery pressures may prevent vasoconstrictor use on initiation of CPB.     

Surgical treatment of thoracoabdominal aortic mural and floating thrombi extending to infrarenal aorta

The case of a 49-year-old man with thoracoabdominal aortic mural and floating thrombi extending to the infrarenal aorta and occlusion of the common iliac artery is described. He had no factors promoting thrombosis, with a history of thrombectomy of the femoral artery. The thoracoabdominal aortic thrombi were successfully removed with a Forgaty catheter through a thoracotomy under simple aortic clamping and subsequent femoro-femoral cardiopulmonary bypass. Intravascular ultrasound performed through the femoral artery after thrombectomy revealed that little mural thrombi remained and that the celiac, superior mesenteric, and bilateral renal arteries were all patent.     

Surgical strategy for repair of large pseudoaneurysms of the aortic isthmus

Resection of unusually large pseudoaneurysms of the aortic isthmus is complex, and involves various strategies of cardiopulmonary bypass (CPB), cerebral and spinal cord protection. We report on a patient with a giant pseudoaneurysm of the distal arch and proximal descending aorta, in whom cannulation of the femoral artery was unfeasible. Instead, the right axillary artery and the left femoral vein were cannulated. This technique allowed to perform a left anterolateral thoracotomy with the patient already on CPB and hypothermic, and to shorten the duration of hypothermic circulatory arrest.     

Replacement of in situ saphenous venous aneurysms with arterial autografts

BACKGROUND: Aneurysm formation in arterialized autologous saphenous veins is an unusual complication of in situ femoral popliteal bypass procedures. METHODS: In a personal series of 207 in situ saphenous femoral popliteal bypass operations, three nonanastomatic venous aneurysms occurred. All three venous aneurysms occurred in male patients who had no adequate autologous vein available as an interposition graft. The use of eversion endarterectomized superficial femoral artery is reported as a substitute interposition graft with long-term results. RESULTS: In the 3 male patients in this series, nonanastomatic aneurysms developed in their in situ saphenous femoral popliteal bypass grafts. The venous aneurysms developed between 5 and 8 years after the original surgical procedure. No adequate vein was available as a replacement for the excised venous aneurysm. Prosthetic conduit was not used owing to the remote possibility of a subclinical infection. A segment of eversion thromboendarectomized superficial femoral artery removed from the same leg was used as a replacement interposition graft in each patient. The in situ venous graft with the autologous interposition thromboendarterectomized superficial femoral artery remained patent until each patient's death 4 to 7 years after the venous aneurysm replacement. CONCLUSIONS: A short segment of endarectomized superficial femoral artery has been found to be a novel solution for the treatment of isolated saphenous vein graft aneurysms when no suitable vein is available. These patients should be maintained on lifelong aspirin therapy owing to the thrombogenic potential of endarectomized artery.     

Mid-term results of peripheric cannulation after port-access surgery

Several minimally invasive approaches, avoiding median sternotomy, have been described within the last few years for cardiac surgery. Femoral arterial and venous cannulation for extracorporeal perfusion are required for many of these operations. The aim of this report is to assess the long-term outcomes of femoral cannulations in patients who underwent minimally invasive procedures. One hundred and sixty patients underwent operations by the port-access method between January 2002 and October 2006. Cardiopulmonary bypass was established by femoral artery-vein cannulation, and a transthoracic clamp was used for the aortic occlusion. One hundred and twenty-one patients were under follow-up in the outpatient clinic and 85 patients underwent Doppler ultrasonography (US) for femoral arterial and venous stenosis. The mean follow-up was 27.9 months (range 1-57 months). There were three hospital mortalities (1.86%), and five late mortalities in this series. The mean follow-up for the Doppler examination was 20.54 months (range 1-56 months). There were two seromas and three wound complications (2.48%), all of which healed after outpatient treatment. All of the flow patterns of the common femoral arteries (CFA) were triphasic except in three of the patients. Three patients (2.48%) were found to have arterial stenosis. One patient with intermittant claudication underwent percutaneous dilatation and stenting of the CFA. Doppler US detected luminal narrowing in two patients who had been having no symptoms, and they are being followed in the outpatient clinic without any complaints. We found a chronic recanalized thrombotic change in the common femoral vein (CFV) in one patient (0.63%). Our study demonstrates vessel patency and/or stenosis in patients without complaints. In conclusion, femoral artery and vein cannulation for port-access surgery with transthoracic clamping can be performed successfully with excellent results in the mid-term.