title: Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia.
abstract: OBJECTIVE
  Recent advance in surgical technique facilitates more aggressive approaches for thoracic aortic diseases. We sought to address the outcomes of our strategy of open distal anastomosis with aortic root replacement using axillary cannulation and moderate hypothermia.
  
  
  METHODS
  A retrospective review of 228 patients who underwent aortic root replacement between July 2004 and December 2007 was performed.
  
  
  RESULTS
  Axillary artery cannulation was successful in 98% of the attempted cases and resulted in no adverse events in 97%. The axillary artery was the site of arterial cannulation in 89% of the cases, among which 136 patients (60% of the cases) underwent an open distal anastomosis, consisting of the cohort of interest. Median age of the patients was 60 years (ranging from 16 to 89 years) with 79% being male. The principal diagnosis for the operation included aneurysmal disease without aortic dissection (78%), type A aortic dissection with or without aneurysm (12%), and endocarditis (5.9%). Performed operations were modified Bentall operation (53% of the cohort), valve-sparing aortic root replacement (26%), and replacement with a homograft (20%). Hemiarch replacement was added in 43%. Mean +/- standard deviation of the lowest temperature was 27 degrees C +/-2.6 degrees C. There were 5 deaths (mortality 3.7%). A total of 16 patients (12%) had major complications.
  
  
  CONCLUSIONS
  Open distal anastomosis at the time of aortic root replacement can safely be performed with axillary artery cannulation and moderate hypothermia. Axillary cannulation provides a reliable route of antegrade cerebral perfusion and enables the complex procedure to be performed without deep hypothermic circulatory arrest.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bowdish
authors.forename: Allan S
authors.initials: AS
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001366:Axillary Artery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002406:Catheterization, Peripheral; D002648:Child; D004696:Endocarditis / Q000601:surgery; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D055815:Young Adult