[HSF] Axillary Artery Cannulation

[Mark Levinson]

On May 2, 2009, at 2:17 AM, Roberto Battellini wrote:

>
> Mark,
>
> please, send a photo and company name of the clamp.

Better yet...here is the article (published in the HSF journal !)

http://www.hsforum.com/vol7/issue3/2004-1020.html

I will find the clamp manufacturers.  There are two clamps with  
slightly different curves.

Mark


>
>
> Roberto
>
>> From: mmlevinson at hsforum.com
>> To: OpenHeart-L at lists.hsforum.com
>> Subject: Re: [HSF] Axillary Artery Cannulation
>> Date: Sat, 2 May 2009 02:06:03 -0500
>> CC:
>>
>>
>> On Apr 23, 2009, at 12:18 AM, john streitman wrote:
>>
>>>
>>> Hal,
>>>
>>> John Streitman here - finished with Tom in 2006 at UF and met you at
>>> the last Southern Thoracic. Tom is dead on. I have done a hemiarch
>>> with a 3 1/2 min circ arrest time with Tom as my assistant and
>>> furthermore using the same technique as he trained us have done well
>>> over 40 hemiarches in the last 3 years here in Pinehurst and am
>>> disappointed if it takes longer than 10 minutes.
>>
>>
>> Fascinating discussion. For non-dissection ascending aneurysms, I
>> have adopted Calafiore's technique, with a circ arrest time of 0.
>> Calafiore designed a special clamp to fit into the upper arch and
>> isolate the underside of the arch. Pump flow from the groin goes over
>> the top of the clamp into the head vessels while you can resect and
>> graft the underside of the arch. My practice ( in a small
>> community hospital) does not yield very many cases of this type, but
>> the Calafiore technique simplified them when they occur. Now, I
>> just cool to 30 C, clamp the arch, sew the distal (in whatever time  
>> it
>> takes) and advance another clamp proximal to the suture line, and  
>> then
>> complete the supracoronary anastomosis etc. The pump stays on
>> throughout.
>>
>> The key is to evaluate the preop CAT for calcification or endoluminal
>> plaque. This technique does not apply when the arch is
>> calcified. But I have done several cases this way, with no strokes
>> and no circ arrest. The clamps are commercially available. (I
>> have not tried this with dissections, where I still use a felt
>> sandwich technique under circ arrest).
>>
>> Mark Levinson, MD.
>> Founder, Editor-in-Chief
>> The Heart Surgery Forum®
>> Multimedia Cardiothoracic Journal
>> URL: http://www.hsforum.com
>> URL: http://newoptionsinheartsurgery.com
>> Emali: mmlevinson at hsforum.com
>>
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> _______________________________________________
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> -----------------------------------------

Mark Levinson, MD.
Founder, Editor-in-Chief
The Heart Surgery Forum®
Multimedia Cardiothoracic Journal
URL: http://www.hsforum.com
URL: http://newoptionsinheartsurgery.com
Emali:  mmlevinson at hsforum.com