masterThesis
Canulacion arterial axilar versus femoral para cirugía del arco aórtico
Fecha
2010Registro en:
TEME 0004 2010
Autor
Gutiérrez Giraldo, Hector Fabio
Institución
Resumen
Objective: Determine if axilary cannulation for selective antegrade cerebral perfusion (SACP) with moderate hypothermia has contributed to improve both morbility mortality and neurological prognosis in patients undergoing aortic arch surgery.
Patients and methods: This revision is retrospective using two cohorts of patients who underwent to urgent or elective arch surgery to compare the two methods of different arterial cannulation: axilary cannulation for selective antegrade cerebral perfusion with moderate hypothermia and femoral cannulation with deep hypothermia in a period of time from December 2002 to August 2008 in the Department of Cardiovascular Surgery in The Fundacion Cardioinfantil in Bogota, Colombia.
Results: 68 patients 50 men and 18 women were operated for aortic arch surgery. 19 patients (27%) with ascending aortic arch aneurysm and 49 patients (72%) from December 2002 to August 2008 with acute or chronic aortic dissection type A. 55 patients (80.9%) underwent axilary cannulation and 13 patients (19, 1%) femoral cannulation. There were no differences found in the preoperative variables between the two groups. The global mortality was of 13,2% (9 patients). All of the deaths were observed in the group with the diagnosis of aortic dissection type A. 55% (38/68) of the patients were operated as urgent surgery. There was no statistically significant difference in mortality in the axilary cannulation group 8 deaths (14,5%) and in the femoral cannulation group1 death (7,7%) (p=0.5). There was no difference found in the incidence of permanent neurological deficit between the two groups. Presenting itself only in two patients with stroke both in the axilary cannulation group (P=0.48). .
Conclusions: Axilary cannulation for selective antegrade cerebral perfusion with moderate hypothermia represents a safe method of cerebral protection, with an acceptable mortality rate and low incidence of permanent neurological complications, there were no differences in the mortality or appearance of adverse neurological events, when compared to the method of arterial femoral cannulation. No complications were found associated to the site of cannulation in either of the two groups.