title: Axillary cannulation for proximal aortic surgery is as safe in the emergent setting as in elective cases.
abstract: BACKGROUND
  Right axillary artery cannulation and selective antegrade cerebral perfusion (SCP) have become well-described strategies in the surgical treatment of proximal aortic disease. Many series report increases in adverse outcomes with SCP used in emergent settings. We compare outcomes in elective and emergent patients.
  
  
  METHODS
  Over 21 months, SCP through right axillary cannulation with a side graft was performed in 61 patients. Thirty-three percent (20 of 61) underwent emergent operation for Stanford type A dissection or intramural hematoma, including 3 of 20 (4.7%) with pericardial tamponade; the remainder of SCP (41 of 61) was elective. The mean follow-up was 9.1 +/- 0.40 months.
  
  
  RESULTS
  Selective antegrade cerebral perfusion was used in 20 of 22 emergent cases (91%), with 2 unsuccessful cannulation attempts, and no peripheral arterial dissections encountered. The SCP flows averaged 16.3 +/- 0.71 cc x kg(-1) x min(-1) for a mean perfusion period of 26.1 +/- 1.9 minutes. The average cardiopulmonary bypass time for all patients was 173 +/- 11 minutes. Average hospital stay was 8.1 +/- 0.80 days. One case (1.3%) of permanent and 3 cases (4.8%) of temporary neurologic dysfunction occurred in SCP patients. The hospital mortality rate for emergent SCP cases (2 of 20, 10%) was not statistically different from the mortality rate for elective SCP cases (3 of 41, 7.3%, p = not significant), with no difference in complication rates. All 3 SCP patients with preoperative tamponade survived without complication. Cerebral oximetry data showed a trend toward decreased left-sided (contralateral) scalp perfusion. There was no association of emergent status with neurologic dysfunction, death, or any other adverse outcome.
  
  
  CONCLUSIONS
  Axillary cannulation and SCP in the surgical treatment of proximal aortic pathology is safe in both elective and emergent settings.
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Budde
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Serna
authors.forename: Susan C
authors.initials: SC
authors.lastname: Osborne
authors.forename: Mark A
authors.initials: MA
authors.lastname: Steele
authors.forename: Edward P
authors.initials: EP
authors.lastname: Chen
mesh_terms: D001018:Aortic Diseases / Q000601:surgery*; D001366:Axillary Artery; D002545:Brain Ischemia / Q000517:prevention & control; D002404:Catheterization; D002536:Cerebral Arteries; D002560:Cerebrovascular Circulation; D017558:Elective Surgical Procedures; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods*