Objective: Cardiopulmonary bypass via the axillary artery is frequently used especially in aortic dissections. With an increased use of this technique problems were recognized too. We describe the technical problems and complications associated with axillary artery cannulation. Methods: Sixty-five patients underwent cannulation of the axillary artery. The indication for operation was acute aortic dissection type A in 57%, chronic aortic dissection in 8%, aortic aneurysm in 18%, pseudoaneurysm in 3%, and others in 14%. Results: Technical problems and complications occurred in 14%, and in 11% the perfusion had to be switched to either femoral (nZ5) or aortic cannulation (nZ2). Arterial damage or dissection of the axillary artery or the aorta occurred in 0% of the sidegraft technique, whereas they were found in 9% with direct cannulation (PZn.s.). Cannulation problems or insufficient CPB flow due to a narrow vessel occurred in 0% of the sidegraft technique, whereas they were found in 4% with direct cannulation (PZn.s.). Malperfusion in aortic dissections occurred in 20% of the sidegraft technique, whereas they were found in 0% with direct cannulation (PZ0.016). No postoperative complications related to axillary cannulation which were evaluated by clinical examination, such as brachial plexus injury, axillary artery thrombosis or local wound infection were observed. Conclusions: Although axillary artery cannulation is an attractive alternative to femoral cannulation there needs to be an alertness for technical problems. Different complications occur with either direct cannulation or the sidegraft technique and at present it remains the surgeons preference which technique for axillary artery cannulation is used.

The use of antegrade selective perfusion of the lower extremity at the side of peripheral cannulation for port-access perfusion and endoaortic occlusion is of utmost importance in patients undergoing minimally invasive or endoscopic cardiac surgery. NIRS monitoring has proved to be very helpful for the diagnosis of impaired leg perfusion.

Extrakorporale Zirkulation in der Chirurgie der thorakalen Aorta des Erwachsenen Zusammenfassung. Grundlagen: In der Chirurgie der thorakalen Aorta sind eine optimale Organprotektion und die Wahl der Kanülierungsstelle für den kardiopulmonalen Bypass von großer Bedeutung, insbesondere wenn ein tief hypothermer Kreislaufstillstand (DHCA) notwendig ist.Methodik: Standard für die extrakorporale Zirkulation bei Operationen an der thorakalen Aorta ist die Kanülie-rung der Aorta ascendens, Arteria femoralis oder Arteria axillaris. Neben der Kardioplegie wird zur speziellen Organprotektion die antegrade oder retrograde zerebrale Perfusion durchgeführt.Ergebnisse: Bei 277 Patienten mit Operationen an der thorakalen Aorta (50 % akute Fälle) war die Hospitalmortalität 13 %. Die Schlaganfallsrate bei Patienten mit DHCA war 8/135 (5,9 %). Eine signifikante Reduktion der Schlaganfallsrate durch retrograde zerebrale Perfusion (4 % mit RCP vs. 6.4 % ohne RCP) konnte nicht nachgewiesen werden. Bei 6 Patienten mit DHCA und antegrader zerebraler Perfusion wurden keine Schlaganfälle beobachtet. Die Kanülierung der A. axillaris erfolgte in den letzten Jahren in zunehmendem Maße, sie ist zurzeit die erste Wahl bei akuten Aortendissektionen Typ A. Die postoperative Aufenthaltsdauer auf der Intensivstation war 3 (1-72) Tage.Schlussfolgerungen: Mit Hilfe geeigneter Perfusionstechniken zur Hirn-, Rückenmarks-und Herzprotektion sind Operationen an der thorakalen Aorta mit akzeptablem Risiko möglich. Die axilläre Kanülierung gewährleis-tet eine sichere Perfusion aller gefährdeten Organe. Bei tief hypothermem Kreislaufstillstand ist damit auch eine antegrade zerebrale Perfusion möglich mit weiterer Reduktion des Risikos neurologischer Komplikationen.Schlüsselwörter: Kardiopulmonaler Bypass, Aortenaneurysma, zerebrale Perfusion, Arteria axillaris.Summary. Background: In thoracic aortic surgery optimum organ protection and the cannulation sites for extracorporeal circulation are a critical issue, especially if deep hypothermic circulatory arrest is necessary.Methods: Standard cannulation sites for surgery of the thoracic aorta are the ascending aorta, femoral artery, or axillary artery. Specific organ protection is performed as cardioplegia and antegrade or retrograde cerebral perfusion.Results: The hospital mortality of 277 patients (50 % acute cases) undergoing surgery of the thoracic aorta was 13 %. 8/135 (5.9 %) patients undergoing deep hypothermic circulatory arrest (DHCA) had a postoperative new stroke. From 25 patients undergoing retrograde cerebral perfusion 4 % had a new postoperative stroke, whereas of 110 patients undergoing DHCA without cerebral perfusion 6.4 % had a new postoperative stroke (p = n.s.). In 6 patients undergoing antegrade cerebral perfusion and DHCA no stroke was observed postoperatively. Axillary artery cannulation was increasingly used for cardiopulmonary bypass, especially in acute aortic dissection type A. The postoperative length of ICU stay was 3 (1-72) days in the whole series.Conclusions: With adequate perf...

Zusammenfassung. Grundlagen: Die Bentall-Operation stellt eine attraktive Variante des Aortenwurzelersatzes dar und kann in den meisten Fällen von Aortenwurzel-Pathologie beim Erwachsenen indiziert werden. Das operative Vorgehen ist hochstandardisiert.Methodik: Anhand von Literatur und eigenen Erfahrungen werden Hauptindikationen, allgemeine und spezielle technische Aspekte der Operation und Ergebnisse dargestellt.Ergebnisse: Die perioperative Mortalität ist besonders bei der elektiv durchgeführten Bentall-Operation vergleichbar mit jener des elektiven, isolierten Aortenklappenersatzes.Schlussfolgerungen: Niedrige Raten von Komplikationen im Langzeitverlauf machen die Bentall-Operation zu einer sehr attraktiven Option für die pathologisch veränderte Aortenwurzel.Schlüsselwörter: Thorakale Aorta, Aorta ascendens, Aneurysma, Bentall-Operation.Summary. Background: The Bentall operation is a favorable technique of aortic root replacement and can be applied to most cases in adult aortic root pathology. The operative procedure is highly standarized.Methods: We present the main indications, general and special technical aspects of the procedure, and results according to literature data and own experience.Results: Perioperative mortality of the Bentall operation, especially as an elective treatment, is comparable to elective isolated aortic valve replacement.Conclusions: It is the low rate of adverse events during long-term follow-up which make Bentall operations highly attractive as a replacement of pathologic aortic roots.

This paper reviews currently used training models for coronary artery bypass grafting (CABG). Training models for CABG are extremely helpful not only for training surgical techniques, but also for the evaluation of new technologies and for research on bypass graft pathophysiology. Wet-lab models serve as training platforms for surgical residents and allow the evaluation of new technology (e.g., robotically enhanced CABG). The right coronary artery to left anterior descending artery model on the slaughterhouse pig heart is easily available, cheap, and effective. In vivo animal models for CABG are much more sophisticated and cost intensive. Pigs and dogs are the most commonly used animals for CABG training. Offpump CABG techniques, totally endoscopic CABG, endoscopic gastroepiploic artery harvesting, and axillocoronary bypass grafting have been evaluated in animal models.