RU-2861583-C1 - METHOD FOR CENTRAL AORTIC CANNULATION FOR PERFORMING OPEN DISTAL ANASTOMOSIS IN "HEMIARCH" AORTIC ARCH REPLACEMENT

Abstract

FIELD: medicine. SUBSTANCE: invention relates to cardiovascular surgery. Performing a median or mini-J sternotomy, which is carried out under conditions of selective antegrade bihemispherical cerebral perfusion, cardiopulmonary bypass and using moderate hypothermic circulatory arrest. Performing aortotomy of the ascending aorta. Wherein, by means of a Y-connector, bifurcating the arterial line into a 3/8 inch line intended for systemic perfusion and a 1⁄4 inch line intended for cerebral perfusion, which is re-duplicated using a 1⁄4 inch Y-connector and connected to two Foley catheters 18 Fr and 16 Fr positioned in the orifices of the brachiocephalic artery (BCA) and the left common carotid artery (LCCA), respectively. An aortic cannula 18-24 Fr is connected to the systemic perfusion line, wherein a coronary line 1⁄4 inch leading to the reservoir of the heart-lung machine is connected to the port diverter located on the distal end of the aortic cannula 18-24 Fr, and after positioning the clamp on the systemic perfusion line below the port diverter, blood is evacuated from the distal sections of the aorta. EFFECT: reducing the duration of the operation and circulatory arrest, ensuring easy transition to "full" cardiopulmonary bypass (CPB), which does not require recannulation into the vascular prosthesis, in addition, creating the possibility of evacuating blood from the distal sections of the aorta during circulatory arrest, thereby providing conditions for a "dry surgical field". 1 cl, 1 dwg, 1 ex

Inventors

• Bogachev-Prokofev Aleksandr Vladimirovich
• Sharifullin Ravil Makharamovich
• Limanskii Aleksei Dmitrievich
• Makaev Aleksandr Gennadevich
• Makaev Aleksandr Gennadevich

Dates

Publication Date

20260506

Application Date

20250725

Claims (1)

1. A method of central aortic cannulation for performing an open distal anastomosis during hemiarch aortic arch replacement, including performing a median or mini-J sternotomy performed under conditions of selective antegrade bihemispheric cerebral perfusion, artificial circulation and using moderate hypothermic circulatory arrest, with performing an aortotomy of the ascending aorta, characterized in that, by means of a Y-shaped connector, the arterial line is bifurcated into a 3 ⁄ 8 inch diameter line intended for systemic perfusion and a 1 ⁄ 4 inch diameter line intended for cerebral perfusion, which is re-duplicated using a 1 ⁄ 4 inch diameter Y-shaped connector and connected to two 18 Fr and 16 Fr diameter Foley catheters positioned at the mouths of the brachiocephalic artery and the left common carotid artery, respectively; an aortic cannula with a diameter of 18-24 Fr is connected to the systemic line, while a suction line with a diameter of 1 ⁄ 4 inch leading to the reservoir of the artificial circulation apparatus is connected to the port-diverter located at the distal end of the aortic cannula, and, after applying a clamp to the systemic line below the port-diverter, blood is evacuated from the distal parts of the descending aorta.

Description

The invention relates to medicine, namely to cardiovascular surgery, and can be used to reduce the period of circulatory arrest during surgical treatment of aneurysms and dissections of the thoracic aorta. A key aspect of aortic arch (AA) surgery, largely determining its success, is protecting the brain from ischemic damage. Maintaining optimal cerebral function under normothermic conditions requires a constant supply of glucose and oxygen through the blood, which support aerobic glycolysis in neurons. Thus, specialists have 5-7 minutes to reconstruct the AA, which is insufficient for this type of surgical intervention, and acute hypoxia will inevitably lead to irreversible damage to cerebral structures. State of the art The results of the conducted studies demonstrate a relationship between a decrease in temperature and the rate of metabolic reactions in the brain under conditions of circulatory arrest (CA) [1]. According to Mrozek, Ségolène et al., a decrease in body temperature by 1°C leads to a proportional decrease in neuronal metabolism by 5% [2]. However, hypothermia can be maintained at a level of 8-12°C, which is the lower threshold at which autoregulation of cerebral blood flow occurs [3]. Thus, the CA method under conditions of deep hypothermia has become routinely used for aortic arch interventions. However, this method has several disadvantages. These include: a significant increase in surgical time due to prolonged cooling and warming, the lack of a method for effective aeroembolism prevention, and the inability to adequately protect the brain, which, taken together, is characterized not only by neurological but also multiple organ dysfunction in both the early and late postoperative periods [4]. In addition, a technology that combines CA under conditions of deep hypothermia (CHC) and retrograde cerebral perfusion (RCP) is widespread. This method of provision is subject to debate due to the existence of conflicting evidence regarding the effectiveness of this technique. Thus, according to Rylski, Bartosz, et al., RCP in combination with CHC reduces the risk of developing focal neurological complications with a CA duration of approximately 40 minutes [5]. In contrast, according to Reich, David L., and Suzan Uysal., postoperative results using RCP with CHC do not differ from those after the use of isolated CHC [6]. Currently, the "gold standard" of neuroprotection in DA surgery is the use of antegrade cerebral perfusion (ACP) with moderate hypothermic circulatory arrest (MHCA). According to a meta-analysis, this method demonstrates better postoperative long-term survival outcomes compared to isolated HHCA [7]. ACP with MHCA also demonstrates convincing results in reducing transient and persistent neurological complications compared to a group of patients who underwent RPCP with MHCA [8]. To ensure the anatomical conditions for the use of APGM, cannulation of peripheral arteries is often required to ensure perfusion during the CA period. In the case of Stanford type A aortic dissection, according to the 2021 AATS (American Association for Thoracic Surgery) guidelines, the right subclavian artery, brachiocephalic trunk, and femoral artery have the highest recommendation class for cannulation. However, each of these techniques shares a common drawback: manipulation of the corresponding arteries. This increases both the duration of the procedure and the risk of complications associated with the need for surgical exposure of the vessels; in some cases, recannulation of the prosthesis may be necessary due to the inability to establish full artificial circulation (EC). Disclosure of the essence of the invention The technical result of the invention is a reduction in the duration of surgery and circulatory arrest, as well as a comfortable transition to full artificial circulation (EC) without the need for recannulation into a vascular graft. Furthermore, it is possible to evacuate blood from the distal aorta during circulatory arrest, thereby ensuring a "dry surgical site." The problem is solved by the claimed method of central aortic cannulation for performing an open distal anastomosis during aortic arch replacement using the “hemiarch” method, carried out under conditions of selective bihemispheric APGM with UGCA. The method of central aortic cannulation for performing an open distal anastomosis during aortic arch replacement using the hemiarch method includes performing a median or mini-J sternotomy, carried out under conditions of selective antegrade bihemispheric perfusion of the brain, artificial circulation and using moderate hypothermic circulatory arrest, with performing an aortotomy of the ascending aorta. A method characterized in that, by means of a Y-shaped connector, the arterial line is bifurcated into a line with a diameter of 3/8 inch, intended for systemic perfusion, and into a line with a diameter of 1/4 inch, intended for perfusion of the brain , which is again duplicated using a Y-