Comparison of Blood Pressure Measured at the Aortic Cannula Sideport and within the Ascending Aorta after Cardiopulmonary Bypass

Introduction: Emboli events are associated with the aortic cannula insertion and final position in the ascending aorta. However, the impact of subtle changes in aortic cannula movement and flow influencing embolic transport throughout the aortic arch is not well understood. The present study evaluated the aortic cannula’s outflow and orientation effect on emboli entering the aortic branch arteries. Methods: A simplified aortic computational model was anteriorly cannulated in the distal ascending aorta with a 21-French straight aortic cannula, and two orientations were analysed by injecting gaseous and solid emboli at pump flows 2, 3 and 5 L/minute. The first aortic cannula orientation (forward flow cannula) was directed towards the lesser curvature. The second aortic cannula orientation (rear flow cannula) was tilted slightly backwards by 15°, providing flow in the retrograde direction. Results: Forward flow cannula produced a primary arch flow, whereas rear flow cannula produced a secondary arch flow resulting in four times longer emboli arch resident times than forward flow cannula. The rear flow cannula had the highest percentage of gaseous emboli entering the brachiocephalic artery of 8%, 12% and 36% (at 2, 3 and 5 L/minute, respectively). Rear flow cannula provided a positive aortic branch arterial flow at all pump flows, whereas at forward flow cannula, the brachiocephalic artery experienced retrograde flows of −1.0% (3 L/minute) and −4.0% (5 L/minute), with the left common carotid −0.23% (5 L/minute). No significant number of solid emboli entered the aortic branch arteries. Conclusion: This numerical study illustrated distinct trajectory behaviours between gaseous and solid emboli where slight changes in aortic cannula orientation influenced idealised emboli direction with higher pump flows magnifying the effects.

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Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

The Heart Surgery Forum ◽

10.1532/hsf98.20101170 ◽

2011 ◽

Vol 14 (6) ◽

pp. 373 ◽

Cited By ~ 4

Author(s):

Saina Attaran ◽

Maria Safar ◽

Hesham Zayed Saleh ◽

Mark Field ◽

Manoj Kuduvalli ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Dissection ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Ascending Aorta ◽

Type A Aortic Dissection ◽

Complete Rupture

<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>

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Clinical Results of Cardiopulmonary Bypass with Selective Cerebral Perfusion for Aneurysm of the Ascending Aorta and the Aortic Arch

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)60905-8 ◽

1982 ◽

Vol 34 (6) ◽

pp. 659-663 ◽

Cited By ~ 10

Author(s):

Yasuhiro Soma ◽

Kozo Kawada ◽

Nobuatsu Kono ◽

Hiroji Imamura ◽

Ryohei Yotsu ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Clinical Results ◽

Ascending Aorta ◽

Selective Cerebral Perfusion

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Letter by Ge and Kong Regarding Article, “High-Target Versus Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients: A Randomized Controlled Trial”

Circulation ◽

10.1161/circulationaha.118.035995 ◽

2018 ◽

Vol 138 (21) ◽

pp. 2445-2446

Author(s):

Hong-Wei Ge ◽

Fei-Juan Kong

Keyword(s):

Blood Pressure ◽

Randomized Controlled Trial ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Controlled Trial ◽

Target Blood Pressure ◽

Cerebral Injury ◽

Pressure Management ◽

Randomized Controlled ◽

Blood Pressure Management

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Vasomotor waves of arterial blood pressure after cessation of cardiopulmonary bypass in man

Perfusion ◽

10.1177/026765919000500404 ◽

1990 ◽

Vol 5 (4) ◽

pp. 261-266

Author(s):

V. Vainionpää ◽

A. Hollme'n ◽

J. Timisjärvi

Keyword(s):

Blood Pressure ◽

Cardiopulmonary Bypass ◽

Arterial Pressure ◽

Venous Pressure ◽

Systemic Arterial Pressure ◽

Heart Patients ◽

Arterial Blood ◽

Pulmonary Arterial ◽

The Mean ◽

Epicardial Pacing

The occurrence of vasomotor waves during cardiopulmonary bypass (CPB) is a recognized phenomenon. The lesser known oscillation of arterial pressure after cessation of CPB was observed in 18 open-heart patients. The duration of an oscillatory wave was 13.5±5.0 seconds, the amplitude 6.1 ±2.6mmNg and the mean arterial pressure 76.5± 10.7mmHg. Inter-and also intraindividual variations in frequency and amplitude of the oscillation, however, did occur. In 13 patients, this oscillation occurred during ventricular epicardial pacing. The oscillation continued until the end of the operation in eight patients; in others, the oscillation was of shorter duration. An oscillation of pulmonary arterial pressure (PAP) was simultaneously observed in nine patients (eight with pacemaker) and central venous pressure (CVP) oscillation in eight patients (all with pacemaker). The duration of a wave was the same as in systemic arterial pressure and the amplitudes were 1.5-3.0mmHg in PAP and 1.0-2.0mmHg in CVP. These arterial vasomotor waves, seen here after CPB, largely resemble those observed during perfusion in man and also the Mayerwaves explored in experimental animals. The pacing rhythm seems to favourthe appearance of those blood pressure oscillations.

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Impact of valve morphology, hypertension and age on aortic wall properties in patients with coarctation: a two-centre cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-034853 ◽

2020 ◽

Vol 10 (3) ◽

pp. e034853

Author(s):

Niky Ghorbani ◽

Vivek Muthurangu ◽

Abbas Khushnood ◽

Leonid Goubergrits ◽

Sarah Nordmeyer ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Aortic Coarctation ◽

Cross Sectional Study ◽

Ascending Aorta ◽

Uncontrolled Hypertension ◽

Specific Reference ◽

Sectional Study ◽

Cross Sectional ◽

Descending Aorta

ObjectiveWe aimed to investigate the combined effects of arterial hypertension, bicuspid aortic valve disease (BAVD) and age on the distensibility of the ascending and descending aortas in patients with aortic coarctation.DesignCross-sectional study.SettingThe study was conducted at two university medical centres, located in Berlin and London.ParticipantsA total of 121 patients with aortic coarctation (ages 1–71 years) underwent cardiac MRI, echocardiography and blood pressure measurements.Outcome measuresCross-sectional diameters of the ascending and descending aortas were assessed to compute aortic area distensibility. Findings were compared with age-specific reference values. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology statement and reporting guidelines.ResultsImpaired distensibility (below fifth percentile) was seen in 37% of all patients with coarctation in the ascending aorta and in 43% in the descending aorta. BAVD (43%) and arterial hypertension (72%) were present across all ages. In patients >10 years distensibility impairment of the ascending aorta was predominantly associated with BAVD (OR 3.1, 95% CI 1.33 to 7.22, p=0.009). Distensibility impairment of the descending aorta was predominantly associated with arterial hypertension (OR 2.8, 95% CI 1.08 to 7.2, p=0.033) and was most pronounced in patients with uncontrolled hypertension despite antihypertensive treatment.ConclusionFrom early adolescence on, both arterial hypertension and BAVD have a major impact on aortic distensibility. Their specific effects differ in strength and localisation (descending vs ascending aorta). Moreover, adequate blood pressure control is associated with improved distensibility. These findings could contribute to the understanding of cardiovascular complications and the management of patients with aortic coarctation.

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Transaortic Endoclamp for Mitral Valve Operation through Right Minithoracotomy in 369 Patients

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451000500603 ◽

2010 ◽

Vol 5 (6) ◽

pp. 394-399 ◽

Cited By ~ 5

Author(s):

Donald D. Glower ◽

Bhargavi Desai

Keyword(s):

Mitral Valve ◽

Ascending Aorta ◽

Intercostal Space ◽

Safe Alternative ◽

Aortic Clamping ◽

Mitral Valve Operation ◽

Group A ◽

Aortic Cannula ◽

Group B ◽

Valve Operation

Objective The effects and benefits of a transaortic endoclamp for mitral valve operation through right minithoracotomy have not been established. Methods The records were examined in 671 patients undergoing mitral valve operation using aortic cannulation through a 6-cm right minithoracotomy in the fourth intercostal space. The ascending aorta was cannulated with a 24-Fr cannula through a 12-mm port in the first intercostal space. The experience from 1998 to 2006 with aortic endoclamping (group A, N = 436) was compared with the experience from 2006 to 2009 with external aortic clamping (group B, N = 235). Aortic endoclamping was achieved with a 30 mL endoclamp introduced through the aortic cannula into the ascending aorta to provide aortic endoclamping, anterograde cardioplegia, and root venting. Percutaneous femoral venous cannulation was used. Results Group A and group B had similar demographics. Endoclamp availability (group A) resulted in significantly less fibrillatory arrest (no clamping) in 67 of 436 (15%) versus 104 of 235 (44%) patients in group B (P = 0.001). In patients with aortic clamping, endoclamp (group A) versus external clamp (group B) was not a determinant of clamp time or pump time. Hospital and late outcomes were not different between groups. No patient complications could be attributed to the endoclamp. Conclusions Aortic endoclamping requires no more clamp or pump time than external clamping and can provide a more bloodless field than ventricular fibrillation without obstructing hardware. Aortic endoclamping is a safe alternative for mitral surgery through right minithoracotomy.

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Cardiopulmonary Dysfunction And Changes In Production Of TXA2 And PGI2 Induced By Intracoronary Injection With Arachidonic Acid

10.1055/s-0038-1652778 ◽

1981 ◽

Author(s):

I Isohisa ◽

K Tanoue ◽

S Ariga ◽

C Sakakibara ◽

H Yamazaki

Keyword(s):

Blood Pressure ◽

Specific Inhibitor ◽

Ascending Aorta ◽

Intracoronary Injection ◽

St Depression ◽

Propenoic Acid ◽

Significant Difference ◽

Radio Immunoassay ◽

Wedge Pressure ◽

Pressure Catheter

A 4 Wedge-Pressure catheter was inserted to 1 cm above aortic valve in ascending aorta through right common carotid artery of 16 rabbits. 1.5 mg/kg of sodium arachidonate (AA) was injected into the proximal portion of ascending aorta after inflation of balloon which obstructed the ascending aorta. Inflation remained for 5 sec, the solution was perfused into coronary arteries. ECG, respiratory movement and blood pressure were recorded. Before, 3 and 60 min after AA, 10 ml of heparinized blood was collected, added with 0.1 ml of Tris-HCl buffer (pH 8.0) containing indomethacin (10 μM in final concentration) and centrifuged to collect PPP for measurement of TXB2 and 6-Keto PGF1α using radio immunoassay. 8 rabbits were injected with 10 mg/kg of (E)-3-[4-(3- pyridylmethyl)phenyl]-2-methyl-2-propenoic acid (OKY-1580, a specific inhibitor on TXA2 synthetase) 3 min before AA injection. In control, arrhythmia and marked ST depression appeared in all cases after AA. Apnea was seen in 4 and 1 case died 7 min after AA. In OKY group, arrhythmia and apnea were not seen. 2 cases showed ST depression. Blood pressure decreased in both the groups similarly. TXB2 values were 1.091+0.498 ng/ml (mean+SD) before, 3.037±0.927 3 min after and 1.014±0.426 60 min after in control. In OKY group those were 1.3154±). 926, 0.830±0.334 and 0.764±0.343. There was a significant difference in the values 3 min after between both the groups. In control, 6-Keto PGF1α values were 3.337± 2.279 ng/ml before, 26.668±16.353 3 min after and 3.975± 3.548 60 min after. In OKY group, those were 2.151±0.528, 61.064±21.420 and 4.264±2.530. There was also a significant difference in the values 3 min after. Histologic findings of heart showed more remarkable ischemic changes in control than in OKY group. These findings suggest that the intracoronary injection with AA induced ischemic changes in heart through TXA2 synthesis at least partially and the changes were able to be prevented by OKY 1580.

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