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J Thorac Cardiovasc Surg 2003;126:2107
© 2003 The American Association for Thoracic Surgery
Letter to the editor |
Department of Cardiac Surgery, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
We would like to thank Seref A. Kücüker and Oguz Tasdemir for their comments on our article. Unfortunately, when we sent our material to the editorial office we were not aware of their publication.1 The editorial office of the Annals accepted their publication on February 7, 2002, while the article sent by us arrived at the JTCS editorial office on May 3 of the same year.
Our surgical team started the experimental laboratory work for brachial artery cannulation in 1999 for the purpose of ensuring cardiopulmonary bypass and anterograde perfusion in the aortic arch, mainly in the acute aortic dissection operations. This was an interdisciplinary investigation carried out jointly with the Applied and Clinical Anatomical Laboratory, Department of Anatomy, Histology, and Embriology, from the Semmelweis University of Budapest (this laboratory is led by Dr Lajos Patonay); the clinical examinations were performed in the Hand Microcirculation Functional Laboratory from the Medical and Health Science Center, University of Debrecen (Dr Zoltán Csiky and Dr Ildikó Garai). On the basis of the morphological and hemodynamical laboratory investigation results, in 2001 it became possible for us to ensure cardiopulmonary bypass just through brachial artery cannulation.2
In our first patient we carried out left-side brachial cannulation because in addition to the 2 femoral arteries, the right subclavian artery was also effected (namely, the pressure measured in the right side brachial artery was 50 mm Hg lower). In both cases we were able to use 20-F cannulas with the technique described by us (naturally this can vary between 16- and 20F-sized cannulas depending on the patient's build).
It must be mentioned that during cardiopulmonary bypass the pressures measured in the arterial line are higher, therefore we always endeavored to use the thickest cannulas.
Despite there being no immediate clinical consequences from not maintaining the collateral circulation in the subscapular artery, on the basis of the above-mentioned laboratory and clinical hand circulation examinations, we consider it important and worthwhile to position the cannula such that the collateral circulation through the subscapular artery is maintained. It is possible that longer reperfusion under normothermia could lead to temporary neurological complications due to the reduced hand perfusion.
Besides this, it is expedient to cannulate the brachial artery as distally as possible, so that the possible iatrogenic dissection caused by the cannula remains at some distance from the aortic arch. We are convinced that the manufacturing companies, jointly with the clinicians, will further develop the manufacture of this kind of cannula.
Again, we thank Kucuker and Tasdemir for their extremely interesting and valuable work.
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