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J Thorac Cardiovasc Surg 2005;129:1203
© 2005 The American Association for Thoracic Surgery

Letters to the Editor

Reply to the Editor

Steve J. Schomisch, BS, Alan H. Markowitz, MD

University Hospitals of Cleveland Cardiothoracic Surgery 11,100 Euclid Ave Cleveland, OH 44106

Thank you for your interest in our publication entitled "Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli." We are confident that our conclusion, that axillary cannulation reduces cerebral microemboli, is supported by our experimental evidence. We apologize for any lack of clarity with our experimental design. We agree that the distribution pattern of the microspheres might be influenced by the pump flow rate, microsphere injection rate, shape of the aorta, location of the injection, and location of the cardiopulmonary bypass cannulation site. Using each animal as its own control enabled us to provide constant conditions for each variable, with the only difference being the cannulation site.

Our microsphere injection method was consistent for each animal. The only variable was the cannulation site for cardiopulmonary bypass. The pump flow rate was constant during the 2 cannulation techniques within each animal, although the pump rate did vary from 1.9 to 3.4 L · min–1 · m–2 among animals to maintain constant pressure among animals. Five million microspheres (2.5 x 106 microspheres/mL) were injected over 1 minute.

Larger microspheres have been used to induce infarction or ischemia and might have been preferred if that was our intention. We were exclusively interested in the distribution of the spheres and found no evidence that the distribution of 50-µm spheres would have, in our model, altered our impressive results. Atheroemboli range in size, with the most numerous being the smallest.1 We used 15-µm spheres, as has been done before in similar investigations.2

We agree with your suggestion that further characterization of the flow pattern through particle-imaging techniques will provide additional evidence as to the superior ability of axillary cannulation to provide cerebroprotection, and we plan to do so in the future to further corroborate the vastly reduced stroke rate we have observed when axillary perfusion was used in our patients with high-risk aortas.

References

  1. Rapp J, Pan X, Yu B, et al. Cerebral ischemia and infarction from atheroemboli <100 µm in size. Stroke 2003;34:1976-1980.[Abstract/Free Full Text]
  2. Macoviak J, Hwang J, Boerjan K, Deal D. Comparing dual-stream and standard cardiopulmonary bypass in pigs. Ann Thorac Surg. 2002;73:203-208.[Abstract/Free Full Text]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
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Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Alan H. Markowitz
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schomisch, S. J.
Right arrow Articles by Markowitz, A. H.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Schomisch, S. J.
Right arrow Articles by Markowitz, A. H.
Related Collections
Right arrow Cerebral protection
Right arrow Coronary disease
Right arrow Extracorporeal circulation
Right arrow Great vessels
Right arrow Mechanical Circulatory Assistance

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