title: Bilateral axillary artery perfusion to reduce brain damage during cardiopulmonary bypass.
abstract: BACKGROUND
  Theoretically, a multiple perfusion approach, reducing detachment of atheromatous debris from the aortic intima and its flow into the cerebral circulation, should contribute to lessen a stroke, and may be applied to complex cardiac surgery with extensive aortic disease. The aim of the present study was to examine the value of bilateral axillary artery perfusion during thoracic aortic and cardiac surgery, and to evaluate the clinical results with a particular focus on cerebral damage.
  
  
  METHODS
  From March 2002 through December 2007, 24 patients (16 male and eight female; age range, 43 to 84 years) underwent bilateral axillary artery perfusion through side grafts during cardiopulmonary bypass. Aortic surgery, including total arch replacement, hemiarch replacement, and ascending aortic replacement, was performed in 21 patients. Bilateral axillary artery perfusion was also used in three complicated valve surgeries after expanding its indication to cardiac pathology with a diseased aorta, two redo cases with severe atherosclerotic vascular disease, and one case with a porcelain aorta.
  
  
  RESULTS
  Bilateral axillary artery perfusion was successful in all patients. There were no complications related to this procedure except in one patient, who suffered from a local fluid retention in one wound, requiring puncture drainage. There was no hospital mortality. No strokes were identified by either clinical assessments or diagnostic imaging.
  
  
  CONCLUSIONS
  Bilateral axillary artery perfusion is a useful method for protection of the brain during either thoracic aortic or cardiac surgery when the patients have an extensively diseased aorta.
authors.affiliation: Department of Cardiovascular Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. byou-iryou-cvs@city.kitakyushu.lg.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kurisu
authors.forename: Manabu
authors.initials: M
authors.lastname: Hisahara
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ando
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001366:Axillary Artery; D002315:Cardiopulmonary Bypass; D013504:Cardiovascular Surgical Procedures; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome