title: Outcomes after total aortic arch replacement with right axillary artery cannulation and a presewn multibranched graft.
abstract: BACKGROUND
  Several techniques are available for aortic arch replacement. We evaluated our experience with total aortic arch replacement using a presewn multibranched graft and right axillary artery cannulation for brain perfusion.
  
  
  METHODS
  Between 2002 and 2010, 88 patients (mean age, 61.5±14.6 years) underwent total aortic arch replacement by midline sternotomy (27 patients) or bilateral anterior thoracotomy (61 patients). During a brief period of deep hypothermic circulatory arrest (DHCA) (mean duration, 11.0±7.8 minutes), the brachiocephalic arteries were detached from the aorta and clamped. Cerebral perfusion through the right axillary artery was then initiated while the arteries were sequentially attached to the branches of the presewn graft (mean duration: 40.4±9.8 minutes). The ascending aorta and entire arch were replaced in all patients, combined with varying lengths of the descending aorta.
  
  
  RESULTS
  The 30-day mortality rate was 5.7%. Stroke occurred in 3.4%, spinal cord ischemic injury in 3.4% (1 paraplegia, 2 paraparesis), and new-onset renal failure requiring dialysis in 3.4% of patients. The 5-year survival rate was 70.7%±5.5%. All graft branches remained patent during imaging follow-up (mean duration, 2.6±2.2 years). Six patients required reoperation on the graft or contiguous aorta after the initial repair, but no reoperations were required on the aortic arch or its branches. The 5-year rate of freedom from reoperation was 90.4%±4.0%.
  
  
  CONCLUSIONS
  The use of a presewn multibranched graft and hypothermic brain perfusion through the right axillary artery is a safe method for replacement of the aortic arch, resulting in a low incidence of neurologic complications and favorable durability and patency.
authors.affiliation: Missouri Baptist Medical Center, St. Louis, MO 63131, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulik
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Castner
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001366:Axillary Artery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013536:Suture Techniques; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult