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Direct cannulation of the common carotid artery during the ascending aortic or aortic arch replacement

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Abstract

Objective: To evaluate cerebral perfusion using direct cannulation into the common carotid artery. A new technique is needed to protect brain ischemic injury during ascending aortic or aortic arch replacement. Methods: This technique was evaluated for patients who would have difficulty maintaining adequate cerebral perfusion during surgery. The procedure was performed when patients had the following diagnoses: pseudoaneurysm formation in contact with the sternum with the risk of aneurysmal rupture (n=5), acute aortic dissection with compression of the true lumen of the innominate artery by the pseudolumen (n=3), or a large volume of thrombus in the lumen of the aneurysm with the risk of cerebral thromboembolism if standard extracorporeal circulation was used (n=2). The perfusion catheter was cannulated into one side of the common carotid artery (right side: n=6, left side: n=4) and mean perfusion flow rate was found to be 175 mL/min. The operative procedures consisted of ascending aortic and aortic arch replacement with coronary artery bypass grafting in six patients, ascending aortic replacement in 2 patients, and innominate artery reconstruction/innominate artery and right subclavian artery reconstruction in one patient. Results: No cerebral accidents or deaths occurred while patients were hospitalized. We have followed up patients for a mean of 2.1 years (maximum 3.6 years), with no complications noted from the surgical procedure. Conclusions: Direct cannulation of the common carotid artery is a simple, safe, and acceptable cerebral protection for patients undergoing aortic or aortic arch replacement procedures in the patients with these specific conditions.

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Authors and Affiliations

  1. Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, 903-0215, Okinawa, Japan

    Yukio Kuniyoshi MD, Kageharu Koja MD, Kazufumi Miyagi MD, Tooru Uezu MD, Satoshi Yamashiro MD, Katuya Arakaki MD, Katuhito Mabuni MD & Shigenobu Senaha MD

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  1. Yukio Kuniyoshi MD
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  2. Kageharu Koja MD
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  3. Kazufumi Miyagi MD
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  4. Tooru Uezu MD
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  5. Satoshi Yamashiro MD
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  6. Katuya Arakaki MD
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  7. Katuhito Mabuni MD
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  8. Shigenobu Senaha MD
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Kuniyoshi, Y., Koja, K., Miyagi, K. et al. Direct cannulation of the common carotid artery during the ascending aortic or aortic arch replacement. Jpn J Thorac Caridovasc Surg 52, 247–253 (2004). https://doi.org/10.1007/s11748-004-0118-8

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  • DOI: https://doi.org/10.1007/s11748-004-0118-8

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