Cannulation of the Axillary Artery for Cardiopulmonary Bypass: Safeguards and Pitfalls.

BACKGROUND: The ascending aorta is the customary site for arterial cannulation for cardiopulmonary bypass. Favorable experience at our institution and elsewhere using axillary artery cannulation in treating type A aortic dissections has caused us to broaden our indications for using this site for arterial cannulation for cardiopulmonary bypass. METHODS: Medical records, operative notes, and perfusion records were reviewed in all patients in whom the axillary artery was cannulated directly or by a graft for cardiopulmonary bypass from January 1, 2000 through August 30, 2002. RESULTS: Seventy-five patients underwent axillary artery cannulation during the 32-month interval. Eleven patients had ascending aortic dissections, 20 had extensively diseased ascending aortas, and 44 were individuals undergoing repeat cardiac procedures. The right axillary artery was used in 72 patients and the left in 3. In 16 patients the artery was cannulated directly, and in 59 the arterial cannula was inserted into a prosthetic graft that had been anastomosed to the axillary artery. Axillary artery cannulation was satisfactory in 95% (71 of 75) of the cases in which it was used. CONCLUSIONS: Cannulation of the axillary artery for cardiopulmonary bypass is a dependable approach for procedures including reoperations, aortic dissections, and extensively diseased ascending aortas

The Effect of Low-Dose Epsilon-Aminocaproic Acid on Patients Following Coronary Artery Bypass Surgery.

The effect of low-dose epsilon-aminocaproic acid (EACA) on the postoperative course of 46 patients was studied. Patients undergoing coronary artery bypass grafting were randomly selected in two groups. Group 1 (20 patients) received 5 g EACA upon initiation of cardiopulmonary bypass (CPB). Group 2 (26 patients) received no antifibrinolytic drugs prior to CPB. Neither group received antifibrinolytic drugs after CPB. There was no significant difference between the two groups\u27 blood usage on CPB: 0.65 units in Group 1 and 0.60 units in Group 2. After CPB, blood usage significantly differed: 2.2 +/- 1.7 (SD) units in Group 1 and 3.9 +/- 3.0 units in Group 2 (p = 0.033). Significant difference was also demonstrated in postoperative blood loss in the first 24 hours: 1610 +/- 531 ml in Group 1 versus 2025 +/- 804 ml in Group 2 (p = 0.043). Pre-CPB administration of low-dose EACA significantly decreases blood loss and blood usage in the postoperative period

Clinical Evaluation of the LeukoGuard (LG-6) Arterial Line Filter for Routine Open-Heart Surgery.

Research has demonstrated that leucocyte depletion diminishes the deleterious effects that activated neutrophils have on the body following cardiopulmonary bypass (CPB). A clinical evaluation involving 36 patients (18 in each group) was conducted to compare the use of the Pall LG-6 (leucocyte-depleting) arterial line filter with the Pall EC PLUS filter for postoperative complications and lung function on routine open-heart cases. No differences were found between the groups for postoperative chest tube drainage, urine output, on bypass platelet drop, chest X-rays, blood usage and circulating elastase levels. Statistically significant differences were observed between immediately post-CPB pO 2 values and ventilator hours (EC PLUS = 13.3, LG-6 = 9.2). Many of the advantages of using leucocyte depletion that have been illustrated through experimental investigations were comparable to our clinical observations. We conclude that using the LG-6 leucocyte-depleting arterial line filter is a cost-effective method to reduce the complications known as \u27postperfusion\u27 syndrome

Potential Problem When Using the New Lower-Prime Hollow-Fibre Membrane Oxygenators with Uncoated Stainless Steel Heat Exchangers.

A prospective study was conducted to evaluate the trans-oxygenator pressure gradient across three different hollow-fibre membrane oxygenators during routine cardiopulmonary bypass (CPB). Sixty consecutive open-heart surgery patients were randomly divided into three groups each receiving a different model of membrane oxygenator. Inlet and outlet pressures, as well as patients\u27 pressures, blood flow, revolutions per minute and tympanic membrane temperature were recorded every 15 min during CPB. Within the study groups, there were subsets of patients who exhibited high trans-oxygenator pressures. Although most of these episodes were transient and resolved over a period of time, there were several cases during which the high trans-membrane pressures persisted, resulting in decreasing oxygenator performance. In one such case, oxygenator change-out was required. After extensive analysis and review, the only similarities or correlation that could be made were with the marriage of the newer lower-prime hollow-fibre membrane oxygenators (with corresponding narrow blood path) and the integral uncoated stainless steel heat exchangers. Further study needs to be performed to pinpoint the mechanism and pathophysiology that are involved in this phenomenon