• Journal of Chest Surgery
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• 제54권3호
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• pp.179-185
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• 2021

Background: The use of ProGlide as a percutaneous vascular closure device in cardiac surgery remains inconclusive. This study investigated the clinical outcomes of using ProGlide in the percutaneous cannulation of femoral vessels in adult cardiac surgery. Methods: From September 2017 to July 2018, 131 consecutive patients underwent femoral vessel cannulation during cardiac surgery. The ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) with percutaneous cannulation was used in 118 patients (mean age, 55.7±15.5 years). The accessibility of femoral cannulation was evaluated through preoperative computed tomography. For cannulation, sonography was routinely used. The postoperative ankle-brachial index (ABI) was used to evaluate femoral artery stenosis. Results: Of the 118 patients, 112 (94.9%) and 6 (5.1%) underwent minimally invasive cardiac surgery and median sternotomy, respectively. Most femoral cannulations were performed on the right side (98.3%) using 15F to 19F arterial cannulas. The technical success rate of cannulation with ProGlide was 99.2%, with no delayed bleeding or cannulation site-related complications during hospitalization. During follow-up, only 1 patient showed femoral artery stenosis with claudication and was treated with interventional balloon angioplasty. The postoperative ABI revealed no significant difference in functional stenosis between the cannulation and non-cannulation sides (n=86; cannulation vs. non-cannulation, 1.2±0.1 vs. 1.1±0). Conclusion: Percutaneous femoral cannulation with ProGlide was safe and feasible in adult cardiac surgery. This technique may be a good alternative option in patients requiring femoral vessel cannulation for cardiac surgery.

• Journal of Chest Surgery
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• 제57권4호
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• pp.380-386
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• 2024

Background: Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions. Emergency surgery is typically performed under cardiopulmonary bypass immediately after diagnosis, which involves lowering the body temperature to induce total circulatory arrest. Selection of the arterial cannulation site is a critical consideration in cardiac surgery and becomes more challenging in patients with AD. This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs). Methods: This retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center. Results: Among the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p<0.001). The mean length of stay in the intensive care unit was significantly longer in the retrograde group (5±16 days) than in the antegrade group (3±5 days, p=0.013). Nevertheless, no significant difference was found between the groups in the 30-day mortality or postoperative CVA rates (p=0.2 and p=0.7, respectively). Conclusion: Surgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.

• Journal of Chest Surgery
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• 제44권5호
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• pp.338-342
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• 2011

Background: The axillary artery is frequently used for cardiopulmonary bypass, especially in acute aortic dissection. We have cannulated the axillary artery using a side graft or by directly using Seldinger's technique. The purpose of this study was to assess the technical problems and complications of both cannulation techniques. Materials and Methods: From January 2003 to December 2009, 53 patients underwent operations using the axillary artery for arterial cannulation. The axillary artery was cannulated with a side graft in 35 patients (side graft group) and directly using Seldinger's technique in 18 patients (direct group). Results: The results were compared between two groups, focusing on cannulation-related morbidities including neurologic morbidity. Arterial damage or dissection of the axillary artery occurred in 1 (2.9%) patient in the side graft group and in 1 (5.6%) patient in the direct group. Malperfusion and insufficient flow did not occur in either group. There were no postoperative complications related to axillary cannulation, such as brachial plexus injury, compartment syndrome, or local wound infection, in either group. Conclusion: Technical problems and complications of the axillary arterial cannulation in both techniques were rare. Direct arterial cannulation using Seldinger's technique was done safely and more simply than the previous technique. It was concluded that both axillary arterial cannulation techniques are acceptable and it remains the surgeon's preference which technique should be used.

• Clinical Endoscopy
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• 제57권1호
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• pp.96-104
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• 2024

Background/Aims: Selective bile duct or pancreatic duct cannulation remains a significant initial hurdle in endoscopic retrograde cholangiopancreatography (ERCP) despite advances in endoscopy and accessories. This study evaluated our experience with a rotatable sphincterotome in cases of difficult cannulation. Methods: We retrospectively reviewed ERCP cases using TRUEtome, a rotatable sphincterotome, as a rescue device for cannulation at a cancer institute in Japan from October 2014 to December 2021. Results: TRUEtome was used in 88 patients. Duodenoscopes were used for 51 patients, while single-balloon enteroscopes (SBE) were used for 37 patients. TRUEtome was used for biliary and pancreatic duct cannulation (84.1%), intrahepatic bile duct selection (12.5%), and strictures of the afferent limb (3.4%). Cannulation success rates were similar in the duodenoscope and SBE groups (86.3% vs. 75.7%, p=0.213). TRUEtome was more commonly used in cases with steep cannulation angles in the duodenoscope group and in cases requiring cannulation in different directions in the SBE group. There were no significant differences in adverse events between the two groups. Conclusions: The cannulation sphincterotome was useful for difficult cannulations in both unaltered and surgically altered anatomies. It may be an option to consider before high-risk procedures such as precut and endoscopic ultrasound-guided rendezvous techniques.

• Journal of Animal Science and Technology
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• 제66권2호
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• pp.353-365
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• 2024

Rumen cannulation is a surgical technique used to collect rumen contents from ruminants. However, rumen cannulation surgery may potentially impact the composition of the rumen microbiota. This study aimed to examine the longitudinal alterations in the rumen microbiota composition of Hanwoo steers after cannulation surgery. In this study, eight Hanwoo steers were used; four steers underwent rumen cannulation surgery (cannulation group), while the remaining four were left intact (control group). Rumen samples were collected from all eight steers using the stomach tubing method on the day before surgery (day 0) and on postoperative days 1, 4, 7, 10, 14, 17, 21, 24, and 28, resulting in 80 samples (10 timepoints × 8 animals). The microbiota of all 80 samples were analyzed using 16S rRNA gene amplicon sequencing with Quantitative Insights into Microbial Ecology version 2 (QIIME2). There were no significant differences (p > 0.05) in all major phyla and most major genera representing at least 0.5% of total sequences across all 80 samples between the control and cannulation groups on the preoperative and postoperative days. However, while the alpha diversity indices did not differ (p > 0.05) between the two groups on the preoperative day, they significantly differed (p < 0.05) between the two groups on the postoperative days. Further, the overall microbial distribution based on both unweighted and weighted principal coordinate analysis plots significantly differed (p < 0.05) between the two groups on both the preoperative and postoperative days. Orthogonal polynomial contrasts indicated that major genera and microbial diversity in the cannulation group decreased following surgery but returned to their initial states by postoperative day 28. In conclusion, this study demonstrates that rumen cannulation surgery affects some major taxa and microbial diversity, suggesting that the rumen cannulation method can alter the composition of rumen microbiota in Hanwoo steers.

• 한국동물위생학회지
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• 제41권4호
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• pp.221-228
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• 2018

Rumen cannulation is used for nutritional and microbiological research, clinical diagnosis, and rumen component transfaunation. However, the cannulation procedure can affect parameters such as complete blood count findings, serum chemistry, and rumen fluid pH. The objective of this study was to evaluate the health risks related to the rumen cannulation procedure over a 1-month period. We did not identify significant differences in red blood cell numbers or morphologies between pre- and postoperative timepoints. Moreover, no inflammation or infection was detected. Despite the absence of apparent clinical signs after surgery, serum chemistry results revealed changes in blood urea nitrogen levels and the activities of liver enzymes, including aspartate transaminase, lactate dehydrogenase, and creatinine kinase, from postoperative days 1 to 14. Rumen fluid pH, as measured from samples collected via an orogastric tube, was slightly increased after a preoperative fasting period and on postoperative day 1 but decreased thereafter from postoperative day 4, indicating a minor influence of cannulation surgery on ruminal fluid pH. This is the first study to evaluate hematological parameters and rumen pH before and after rumen cannulation surgery in Hanwoo cattle. Further research is required to better elucidate the potential effects of rumen cannulation surgery on animal health.

• Journal of Chest Surgery
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• 제25권1호
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• pp.17-22
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• 1992

The alterations in serum and urine potassium were studied in twenty two patients who underwent open heart surgery using extracorporeal circulation from June 1990 to August 1990 at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kei-myung University. There were fifteen cases congenital heart disease and seven acquired heart disease. The serum and urine potassium levels were measured pre-, intra- and postoperatively until seventh postoperative day using ionic selective electrode measuring method. After general anesthesia, the serum potassium level decreased significantly but slowly increased during.cardiopulmonary bypass and returned preoperative level after operation. The urine potassium level decreased slowly from general anesthesia to cardiopulmonary bypass weaning but returned preoperative level following operation. During cardiopulmonary bypass, serum and urine potassium levels in diuretic group were lower than that of non diuretic group. There was no remarkable difference in the serum potassium level between single RA cannulation group and bicaval cannulation group preoperatively, but the serum potassium level in single RA cannulation group was much higher than that of bicaval cannulation group. There was no significant difference in the urine potassium level between single RA can-nulation group and bicaval cannulation group postoperatively.

• Journal of Chest Surgery
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• 제45권2호
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• pp.85-90
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• 2012

Background: At present, many surgeons prefer axillary artery cannulation because it facilitates antegrade cerebral perfusion and may diminish the risk of cerebral embolization. However, axillary artery cannulation has not been established as a routine procedure because there is controversy about its clinical advantage. Materials and Methods: We examined 111 patients diagnosed with acute type A aortic dissection between January 2000 and December 2009. The right axillary artery was cannulated in 58 patients (group A) and the femoral artery was cannulated in 53 (group F). The postoperative outcomes were retrospectively reviewed and compared between the two groups. Results: There were 46 male and 65 female patients with a mean age of $58.9{\pm}13.1$ years (range, 26 to 84 years). The extent of aortic replacement in both groups did not differ. There were 8 early deaths (7.2%) and 2 late deaths (1.8%). The mean follow-up duration was $46.0{\pm}32.6$ months (range, 1 month to 10 years). Transient neurologic dysfunction was observed in 11 patients (19.0%) in group A and 14 patients (26.4%) in group F. A total of 11 patients (9.9%) suffered from a permanent neurologic dysfunction. Early and delayed stroke were observed in 6 patients (10.3%) and 2 patients (3.4%), respectively, in group A as well as 2 patients (3.8%) and 1 patient (1.9%), respectively, in group F. There were no statistical differences in the cannulation-related complications between both groups (3 in group A vs. 0 in group F). Conclusion: There were no differences in postoperative neurologic outcomes and cannulation-related complications according to the cannulation sites. The cannulation site in an aortic dissection should be carefully chosen on a case-by-case basis. It is important to also pay attention to the possibility of intraoperative malperfusion syndrome occurring and the subsequent need to change the cannulation site.

• 대한의용생체공학회:의공학회지
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• 제36권4호
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• pp.135-142
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• 2015

Outflow cannulation site of left ventricular assist device(LVAD) chosen by considering anatomical structure of thoracic cavity and vascular system. Though outflow cannulation site influences blood perfusion at each branch, there is no standard rule or quantitative data. In this study, we computed the amount of blood perfusion at each arterial branch numerically according to outflow cannulation sites(ascending aorta, aortic arch, descending aorta). We generated computational meshes to the three-dimensionally reconstructed arterial system. Clinically measured arterial pressure were used for inlet boundary condition, porous media were applied to mimic blood flow resistance. Blood perfusion through left common carotid artery was 2.5 times higher than other cases, and that through right common carotid artery was 1.1 times higher than other branches. Although this is simulation study, will be useful reference data for the clinical study of LVAD which considers blood perfusion efficiency.

• 가정간호학회지
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• 제30권1호
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• pp.48-58
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• 2023

Purpose: The purpose of this study was to construct a nomogram for predicting difficulty in peripheral intravenous cannulation (DPIVC) for adult inpatients. Methods: This study conducted a secondary analysis of data from the intravenous cannulation cohort by intravenous specialist nurses at a tertiary hospital in Seoul. Overall, 504 patients were included; of these, 166 (32.9%) patients with failed cannulation in the first intravenous cannulation attempt were included in the case group, while the remaining 338 patients were included in the control group. The nomogram was built with the identified risk factors using a multiple logistic regression analysis. The model performance was analyzed using the Hosmer-Lemeshow test, area under the curve (AUC), and calibration plot. Results: Five factors, including vein diameter, vein visibility, chronic kidney disease, diabetes, and chemotherapy, were risk factors of DPIVC. The nomogram showed good discrimination with an AUC of 0.81 (95% confidence interval: 0.80-0.82) by the sample data and 0.79 (95% confidence interval: 0.74-0.84) by bootstrapping validation. The Hosmer-Lemeshow goodness-of-fit test showed a p-value of 0.694, and the calibration curve of the nomogram showed high coherence between the predicted and actual probabilities of DPIVC. Conclusion: This nomogram can be used in clinical practice by nurses to predict DPIVC probability. Future studies are required, including those on factors possibly affecting intravenous cannulation.