[HSF] Aortic dissection and CPR-ascending aortic cannulation
hgrmd at aol.com
hgrmd at aol.com
Mon Sep 17 21:13:54 EDT 2007
Roberto,
I used the right axillary artery today on a Bentall. He was a big guy, so I just placed the cannula via a guidewire through a pursestring. His artery was quite deep with limited exposure. I don't think I could have easily sewn a graft to the side of it. He's doing well, though preop sleep apnea (on nightly BIPAP) precludes extubation until morning.
Hal
-----Original Message-----
From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
To: OpenHeart-L at lists.hsforum.com
Sent: Mon, 17 Sep 2007 10:32 am
Subject: AW: AW: [HSF] Aortic dissection and CPR-ascending aortic cannulation
Mr Bachet writes axillary artery in page 980, I have the article in my
ands.Again, EJCTS 2007, June
he second choice is mine, taken from Urbanski who uses left carotid as
irst choice.
oberto
----Ursprüngliche Nachricht-----
on: openheart-l-bounces at lists.hsforum.com
mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von David Harris
esendet: Samstag, 15. September 2007 23:00
n: OpenHeart-L at lists.hsforum.com
etreff: Re: AW: [HSF] Aortic dissection and CPR-ascending aortic
annulation
Did Dr Bachet not say on the HSF that his first choice
s innominate artery?
ave
-- "Dr. Roberto Battellini"
battr at medizin.uni-leipzig.de> wrote:
> Please, read the comments of Dr Bachet in an
editorial of the European jour
Cardioth Surg 2007;31:979-81
First choice. Axillary, second: carotid. Look also
for Urbanski papers in
JTCVS and Annals about carotid cannulation.
Roberto
-----Ursprüngliche Nachricht-----
Von: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] Im
Auftrag von nand kejriwal
Gesendet: Freitag, 14. September 2007 08:32
An: OpenHeart-L at lists.hsforum.com
Betreff: Re: [HSF] Aortic dissection and CPR
No Ani,
I am not sure at all, because I have never used
transapical.However, it
should be quicker than femoral. The one advantage of
femoral I find is that
if the external massage is generating enough output,
we do not have to
discontinue it until we are on bypass.
My understanding is that the surgeons who use
direct aortic cannulation do
so under TOE guidance to make sure that the cannula
is in the true lumen.
Perhaps in a desperate situation, one would like to
take a chance and hope
that it won't malperfuse.
Nand
On 9/14/07, Ani Anyanwu <anianyanwu at hotmail.com>
wrote:
>
> Nand
>
> Are you sure transapical is quickest? I would like
to hear from surgeons
> who actually use this approach in practice, but I
doubt that it would
truly
> be the quickest for surgeons not experienced in
its use. For what is
already
> a desperate tense situation, making an LV incision
and guiding a cannula
> into the aorta may not be as simple as it sounds.
>
> IMHO the quickest way if patient is in extemis or
malperfusing is to
> cannulate the dissection directly and as all
surgeons are used to the
> manouver of aortic cannulation they should be able
to effect it even in
> emergency. Several groups use direct cannulation
for all dissections and
> from what I understand it does not matter whether
the cannula ends up in
> true or false lumen provided the patient foes not
malperfuse (had one last
> year where on opening the cannula tip was clearly
in false lumen but the
> patient perfused okay).
>
> Ani
>
>
>
>
>
> > Date: Thu, 13 Sep 2007 21:43:45 +1200> From:
nkkejriwal at gmail.com> To:
> OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF]
Aortic dissection and
> CPR> CC: > > We had two patients in the unit who
arrested before reaching
> the OR. None of> them survived the repair.
Recently, I had another case
who
> arrested while> being transferred to theatre. He
was intubated and CPR
> continued. My initial> plan was to establish
bypass through femoral
vessels
> while someone else was> massaging. However even
external massage was not
> producing enough pressure> and this had been going
on for over 10 minutes.
> TEE revealed pericardium> full of blood with empty
heart. I did not
> proceed.> > John> > I agree that the quickest way
to institute bypass
would
> be transapical. What> cannula do you use?> Nand> >
On 9/11/07,
> jbflegejr at aol.com <jbflegejr at aol.com> wrote:> >> >
I have had salvage of
> two patients who ruptured while on the operating>
> table as they were
> prepared for anesthesia. They had not been
induced> > completely but we
> opened there sternum anyway. One had femoral
artery> > cannulation by a
> colleague, the other I cannulated through the> >
ascending aorta as
recently
> described by Curt Tribble. Both had no> >
neurologic sequale. In one
during
> the excitement I made the disal> > anastamosis a
bit tight in effect
causing
> an ascending aortic> > coarctation and he got
hemoytic anemia from
> intraluminal felt and a> > year or so later I
resected the area. If I
> encounter another case> > needing immediate
cannulation, I will cannulate
> the ascending aorta> > through the LV apex which
is quick and works well.
I
> had another> > patient who presented in the ER in
shock and with
hyperacute
> ischemic> > ECG changes across the anterior leads.
He had been worked up
and
> a> > diagnosis of ascending aortic aneurysm and
aortic insufficiency and>
>
> normal coronary arteries established and operation
scheduled for the> >
day
> after Christmas but he came back the day before
Christmas and went> >
> straight to the OR. He had a Type A dissection
extending into and> >
> obstructing the Left coronary. I replaced the
ascending aorta which> >
> relieved the coronary obstruction and replaced the
valve with a> >
> Starr-Edwards valve. This was 35 years ago. About
25 years post op he> >
had
> a CT scan for some reason and the radiologist saw
that he had an> > aortic
> dissection down to the femorals and got rather
excited about it> > and
sent
> me the films. I did not recommend treatment. In
modern times> > this kind
of
> patient would have an aortic root replacement.
John Flege> >> >> >
> -----Original Message-----> > From:
tdmartin2000 at aol.com> > To:
> OpenHeart-L at lists.hsforum.com> > Sent: Mon, 10 Sep
2007 9:06 pm> >
> Subject: Re: [HSF] Aortic dissection and CPR> >>
>> >> >> >> >> > Most of
> these pts with sudden deterioration have rupture
into their> >
pericardium>
> > and are not salvageable. I have attempted on
multiple occasions and> >
> have had 2> > that we got out of the OR only to
have anoxic cerebral
deaths.
> If they> > have> > tamponade, CPR does no good, as
you cannot fill. One of
> the ones we got> > out of> > the OR actually had
arrest right after
> induction of anesthesia and we> > were on> > pump
in under 10 min.> >> >>
>>
> > Tom Martin> >> > U of Florida> >> > Gainesville>
>> >> > -----Original
> Message-----> > From: james le
<jamesle2007 at yahoo.com>> > To:
> OpenHeart-L at lists.hsforum.com> > Sent: Mon, 10 Sep
2007 6:35 am> >
> Subject: [HSF] Aortic dissection and CPR> >> >> >>
>> > We recently had a
> case of Aortic dissection transferred from some> >
other> > hospital for
> surgery. He had dissection aorta involving the
entire> > aorta along> >> >
> with severe AR.> > On arrival BP was 90 systolic,
all pulses palpable and
> there> > was no> > neurological deficit> > At ER
he suddenly developed
> severe Bradycardia and arrested and> >
resuscitation was unsuccessful. TEE
> done after death showed only> > small amount> > of
pericardial
collection.>
== message truncated ===
r. David G. Harris, FCS, MMED,
ardiothoracic Surgeon
uite 207
uils River Private Hospital,
O Box 1200, Kuils River, 7579, Cape Town, South Africa.
el +27-21-9006411
ax +27-21-9006412 Mobile +27-83-3309587
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