[HSF] Aortic dissection and CPR-ascending aortic cannulation
hgrmd at aol.com
hgrmd at aol.com
Wed Sep 19 18:30:52 EDT 2007
Ani,
I wish you had been there to see the axillary artery I had to cannulate last Monday. I'm telling you it was deep as heck in a man weighing around 300 lbs. Anyway, I really appreciate the warning about the Seldinger technique. I'll try Dr. Griepp's cannula. As I've told you, he is one of my all time favorite big shots in our field.
Hal
-----Original Message-----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Wed, 19 Sep 2007 11:51 am
Subject: RE: [HSF] Aortic dissection and CPR-ascending aortic cannulation
Hal
he axillary artery is practically never too deep to sew a graft on. We use it
ery liberally, up to 200 cannulations here a year, and even in the most
uscular of young men it is readily assessable through a 5 cm incision to either
ew a graft (which is my preference) or cannulate directly with a specially
esigned short right angled axillary artery cannula developed I think by by Drs
rgin and Griepp and now marketed by Edwards. Dr Griepp advises strongly against
annulation using a guidewire as you risk intimal injury or dissection to the
ubclavian (which tends to be fragile) or arch, and also especially in the young
arfanoids or older atherosclerotics the artery can literally fall apart and
econstructing this will become an operation in itself. We have abandoned
ttempts to cannulate the artery on a few occasions - generally because of
njury to the vessel, but never because of depth or inaccessibility.
ni
> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Aortic dissection and
PR-ascending aortic cannulation> Date: Mon, 17 Sep 2007 20:13:54 -0400> From:
grmd at aol.com> CC: > > > Roberto,> > I used the right axillary artery today on
Bentall. He was a big guy, so I just placed the cannula via a guidewire
hrough a pursestring. His artery was quite deep with limited exposure. I
on't think I could have easily sewn a graft to the side of it. He's doing
ell, though preop sleep apnea (on nightly BIPAP) precludes extubation until
orning.> > > > Hal> > > -----Original Message-----> From: Dr. Roberto
attellini <battr at medizin.uni-leipzig.de>> To: OpenHeart-L at lists.hsforum.com>
ent: Mon, 17 Sep 2007 10:32 am> Subject: AW: AW: [HSF] Aortic dissection and
PR-ascending aortic cannulation> > > > > Mr Bachet writes axillary artery in
age 980, I have the article in my> ands.Again, EJCTS 2007, June> he second
hoice is mine, taken from Urbanski who uses left carotid as> irst choice.>
berto> > ----Ursprüngliche Nachricht-----> on: openheart-l-bounces at lists.hsforum.com>
ailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von David Harris>
sendet: Samstag, 15. September 2007 23:00> n: OpenHeart-L at lists.hsforum.com>
treff: Re: AW: [HSF] Aortic dissection and CPR-ascending aortic> annulation>
id Dr Bachet not say on the HSF that his first choice> s innominate artery?>
ve> > -- "Dr. Roberto Battellini"> battr at medizin.uni-leipzig.de> wrote:> >
lease, read the comments of Dr Bachet in an> editorial of the European jour>
ardioth Surg 2007;31:979-81> First choice. Axillary, second: carotid. Look
lso> for Urbanski papers in> JTCVS and Annals about carotid cannulation.>
oberto> > -----Ursprüngliche Nachricht-----> Von: openheart-l-bounces at lists.hsforum.com>
mailto:openheart-l-bounces at lists.hsforum.com] Im> Auftrag von nand kejriwal>
esendet: Freitag, 14. September 2007 08:32> An: OpenHeart-L at lists.hsforum.com>
etreff: Re: [HSF] Aortic dissection and CPR> > No Ani,> > I am not sure at all,
ecause I have never used> transapical.However, it> should be quicker than
emoral. The one advantage of> femoral I find is that> if the external massage
s generating enough output,> we do not have to> discontinue it until we are on
ypass.> > My understanding is that the surgeons who use> direct aortic
annulation do> so under TOE guidance to make sure that the cannula> is in the
rue lumen.> Perhaps in a desperate situation, one would like to> take a chance
nd hope> that it won't malperfuse.> > Nand> > On 9/14/07, Ani Anyanwu
anianyanwu at hotmail.com>> wrote:> >> > Nand> >> > Are you sure transapical is
uickest? I would like> to hear from surgeons> > who actually use this approach
n practice, but I> doubt that it would> truly> > be the quickest for surgeons
ot experienced in> its use. For what is> already> > a desperate tense
ituation, making an LV incision> and guiding a cannula> > into the aorta may
ot be as simple as it sounds.> >> > IMHO the quickest way if patient is in
xtemis or> malperfusing is to> > cannulate the dissection directly and as all>
urgeons are used to the> > manouver of aortic cannulation they should be able>
o effect it even in> > emergency. Several groups use direct cannulation> for
ll dissections and> > from what I understand it does not matter whether> the
annula ends up in> > true or false lumen provided the patient foes not>
alperfuse (had one last> > year where on opening the cannula tip was clearly>
n false lumen but the> > patient perfused okay).> >> > Ani> >> >> >> >> >> > >
ate: Thu, 13 Sep 2007 21:43:45 +1200> From:> nkkejriwal at gmail.com> To:> >
penHeart-L at lists.hsforum.com> Subject: Re: [HSF]> Aortic dissection and> > CPR>
C: > > We had two patients in the unit who> arrested before reaching> > the OR.
one of> them survived the repair.> Recently, I had another case> who> >
rrested while> being transferred to theatre. He> was intubated and CPR> >
ontinued. My initial> plan was to establish> bypass through femoral> vessels> >
hile someone else was> massaging. However even> external massage was not> >
roducing enough pressure> and this had been going> on for over 10 minutes.> >
EE revealed pericardium> full of blood with empty> heart. I did not> >
roceed.> > John> > I agree that the quickest way> to institute bypass> would> >
e transapical. What> cannula do you use?> Nand> >> On 9/11/07,> >
bflegejr at aol.com <jbflegejr at aol.com> wrote:> >> >> I have had salvage of> > two
atients who ruptured while on the operating>> > table as they were> > prepared
or anesthesia. They had not been> induced> > completely but we> > opened there
ternum anyway. One had femoral> artery> > cannulation by a> > colleague, the
ther I cannulated through the> >> ascending aorta as> recently> > described by
urt Tribble. Both had no> >> neurologic sequale. In one> during> > the
xcitement I made the disal> > anastamosis a> bit tight in effect> causing> > an
scending aortic> > coarctation and he got> hemoytic anemia from> > intraluminal
elt and a> > year or so later I> resected the area. If I> > encounter another
ase> > needing immediate> cannulation, I will cannulate> > the ascending aorta>
through the LV apex which> is quick and works well.> I> > had another> >
atient who presented in the ER in> shock and with> hyperacute> > ischemic> >
CG changes across the anterior leads.> He had been worked up> and> > a> >
iagnosis of ascending aortic aneurysm and> aortic insufficiency and>> >> >
ormal coronary arteries established and operation> scheduled for the> >> day> >
fter Christmas but he came back the day before> Christmas and went> >> >
traight to the OR. He had a Type A dissection> extending into and> >> >
bstructing the Left coronary. I replaced the> ascending aorta which> >> >
elieved the coronary obstruction and replaced the> valve with a> >> >
tarr-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> >
issection down to the femorals and got rather> excited about it> > and> sent> >
e 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:> >
penHeart-L at lists.hsforum.com> > Sent: Mon, 10 Sep> 2007 9:06 pm> >> > Subject:
e: [HSF] Aortic dissection and CPR> >>> >> >> >> >> >> > Most of> > these pts
ith sudden deterioration have rupture> into their> >> pericardium>> > > and are
ot salvageable. I have attempted on> multiple occasions and> >> > have had 2> >
hat we got out of the OR only to> have anoxic cerebral> deaths.> > If they> >
ave> > tamponade, CPR does no good, as> you cannot fill. One of> > the ones we
ot> > out of> > the OR actually had> arrest right after> > induction of
nesthesia and we> > were on> > pump> in under 10 min.> >> >>> >>> > > Tom
artin> >> > U of Florida> >> > Gainesville>> >> >> > -----Original> >
essage-----> > From: james le> <jamesle2007 at yahoo.com>> > To:> >
penHeart-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
ortic dissection transferred from some> >> other> > hospital for> > surgery. He
ad dissection aorta involving the> entire> > aorta along> >> >> > with severe
R.> > On arrival BP was 90 systolic,> all pulses palpable and> > there> > was
o> > neurological deficit> > At ER> he suddenly developed> > severe Bradycardia
nd arrested and> >> resuscitation was unsuccessful. TEE> > done after death
howed only> > small amount> > of> pericardial> collection.>> > == message
runcated ===> > r. David G. Harris, FCS, MMED,> ardiothoracic Surgeon > uite
07 > uils River Private Hospital, > O Box 1200, Kuils River, 7579, Cape Town,
outh Africa. > el +27-21-9006411 > ax +27-21-9006412 Mobile +27-83-3309587>
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