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Unilateral carotid cannulation using a side graft facilitate minimal invasive surgery of the ascending aorta and aortic arch
Rainer Leyh, Constanze Bening, Dejan Radakovic, Christoph Schimmer, Mehmet Oezkur, Ivan Aleksic, Khaled Hamouda.
Medical University Wuerzburg, Wuerzburg, Germany.

OBJECTIVE: The impact of arterial cannulation of right carotid artery using a side graft in combined aortic valve, ascending aortic surgery with and without arch surgery using a minimal invasive upper hemi-sternotomy has not been evaluated yet. This study evaluates the clinical outcome of this technique.
METHODS: Between 7/2012 and 12/ 2015, 33 patients underwent aortic valve and replacement of the ascending aorta with and without arch surgery in a minimal invasive technique with an upper hemi-sternotomy at our institution. Arterial return of the cardiopulmonary bypass was performed in all patients via cannulation of right carotid artery using a side graft. In patients requiring aortic arch surgery unilateral cerebral perfusion was performed using this side graft.
RESULTS: 27.3% (9/33) of patients required aortic root replacement and 58% (19/33) aortic arch surgery. The cardiopulmonary bypass time and aortic cross clamp time was 131±44min and 83±34min, respectively. The duration of circulatory arrest with unilateral cerebral perfusion in patients with aortic arch surgery was 14±4min. Brain perfusion was performed at a blood temperature of 25°C and a flow rate of 0.7± 0.2 l min-1 . Median ventilation time and ICU stay time was 15 hours and 1 day, respectively. Prolonged ventilation time (>24h) was necessary in 9.1% (3/33), 51% (17/33) required red blood cell transfusion with a median of 1 unit each. Re-thoracotomy for bleeding was performed in 6.1% (2/33). According to AKIN-classification stage I acute kidney injury developed in 21.2% (7/33) and stage III, requiring temporal renal replacement therapy in 3% (1/33), respectively. There was no 30-day mortality. One patient with severe calcification of the aortic valve suffered a minor embolic stroke.
CONCLUSIONS: These preliminary data indicate that arterial cannulation of right carotid artery using a side graft is an efficient and safe method for combined surgery of the aortic valve, ascending aorta and aortic arch in a minimal invasive technique using upper hemi-sternotomy.


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