AW: [HSF] Axillary artery cannulation, why with prosthesis?

[Rwmfglycar at aol.com]

In a message dated 1/1/2007 1:14:28 A.M. Eastern Standard Time,  
tacuff at swbell.net writes:

My  senior partner since retired told me long ago that a graft sown to the 
aorta  was the standard cannulation in Dallas when he got here in the seventies. 
 Comments from those that practiced  then?
Tea




In the first extracorporeal cases that I saw we used subclavian  cannulation 
(we were working through bilateral anterior thoracotomies). The  cannula was 
short (about 3 cm) and because it was made of steel had a very  good internal 
versus  external diameter ratio. This combination made for  very low 
resistance. When we switched to median sternotomy and femoral  cannulation the femoral 
cannulae were on the same principle. When I started my  own cases in 1962 I  
had decided that my alma mater was wrong about what  constituted adequate bypass 
flow (1.8 to 2.2 liters/min/ m2) and tried always to  flow at 2.5 - 3.0 
l/min/m2.
When we started to do smaller and smaller infants, cannulae on this  
principle were excellent for allowing proper flows. For me this was essential  since I 
was never happy with the idea that long periods of absent circulation  were 
OK for the brain. The plastic cannulae that came along later did not have  
nearly as good an internal to external diameter ratio and were mostly  
substantially longer.
By the way I think a line from the pump directly connected to a  short 8mm 
graft is an excellent form of arterial cannulation,
I have not mentioned the labor involved in cleaning the reusable cannulae,  
not to mention the screens or discs,
Bob