Evolving arch surgery using integrated antegrade selective cerebral perfusion: impact of axillary artery perfusion.
OBJECTIVE
The study objective was to determine the impact of integrated antegrade selective cerebral perfusion with right axillary artery perfusion during arch surgery.


METHODS
All surgeries were performed through a median sternotomy. Direct cannulation of the right axillary artery in the axilla was used for cardiopulmonary bypass and antegrade selective cerebral perfusion under hypothermia. In addition, ascending aortic or femoral artery perfusion was used. The clinical records of 531 patients (median age, 72 years) between 1999 and 2006 were reviewed, of whom 137 patients (25.8%) underwent emergency surgery. There were 164 dissecting and 367 nondissecting aortic lesions. The surgeries included total arch replacement in 431 patients, partial arch replacement in 9 patients, and hemiarch replacement in 91 patients.


RESULTS
The early mortality rate was 4.0% (2.3% of 30-day mortality and 1.7% of in-hospital mortality). The incidence of permanent neurologic dysfunction was 2.9% in all (3.3% in total arch replacement and 1.0% in hemiarch or partial arch replacement). The incidence of temporary dysfunction was 9.9% in all (10.6% in total arch replacement and 7.0% in hemiarch or partial arch replacement). Multivariate analysis demonstrated that the risk factors for early mortality were chronic renal failure, ruptured nondissecting aneurysm, and prolonged surgery. The midterm survival was 87.2% +/- 1.7% at 3 years and 80.5% +/- 2.6% at 5 years.


CONCLUSIONS
Right axillary artery perfusion is an advantageous adjunct to cardiopulmonary bypass and antegrade selective cerebral perfusion in arch surgery.
Ogino
Hitoshi
H
Department of Cardiovascular Surgery, National Cardiovascular Center, Aichi, Japan. hogino@hsp.ncvc.go.jp
Sasaki
Hiroaki
H
Minatoya
Kenji
K
Matsuda
Hitoshi
H
Tanaka
Hiroshi
H
Watanuki
Hirotaka
H
Ando
Motomi
M
Kitamura
Soichiro
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001366:Axillary Artery; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods