Total arch replacement using bilateral axillary antegrade selective cerebral perfusion.
OBJECTIVE
The prevention of cerebral injury is an important consideration during the repair of an aortic arch aneurysm, and this is a major goal of cerebral protection techniques. We describe extended thoracic aortic aneurysms treated by use of our current surgical strategy.


METHODS
From January 2001 to June 2008, a total of 17 patients (12 men and 5 women; mean age 67.3 ± 7.3 yrs) underwent total arch replacement using bilateral axillary arterial perfusion. Six and 11 had nondissecting and dissecting aneurysms, respectively. Four patients (23.5%) with an impending ruptured aneurysm of the arch aorta or acute type A dissection underwent emergency surgery. We used bilateral axillary arteries for systemic as well as selective cerebral perfusion during the procedures.


RESULTS
One patient died in the hospital (mortality rate, 5.9%) because of multiple organ failure. Mechanical ventilation was required after surgery for 4.6 ± 3.1 days. Permanent neurological dysfunction did not arise in this series. Although prolonged mechanical ventilation support was necessary, all patients recovered uneventfully from the procedures.


CONCLUSIONS
We consider that median sternotomy, along with the left anterolateral thoracotomy approach and perfusion from the bilateral axillary arteries, illustrates the safety of the method. Moreover, our results suggested that perfusion from the bilateral axillary arteries can help to prevent cerebral damage.
Division of Thoracic and Cardiovascular Surgery, Department of Bioregulatory Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Satoshi
S
Yamashiro
Yukio
Y
Kuniyoshi
Katsuya
K
Arakaki
Hitoshi
H
Inafuku
Yuji
Y
Morishima
Yuya
Y
Kise
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001366:Axillary Artery / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D001927:Brain Diseases / Q000209:etiology / Q000517:prevention & control*; D054022:Cerebrum / Q000098:blood supply; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*