title: Midterm results of axilloaxillary cardiopulmonary bypass.
abstract: BACKGROUND
  Total axilloaxillary cardiopulmonary bypass (CPB) is an alternative peripheral cannulation technique that has the advantages of antegrade flow during CPB, monohemispherical brain perfusion in case of circulatory arrest, and achieving excellent decompression of the heart during sternotomy. The results of this strategy, particularly beyond the immediately postoperative period, are not well known.
  
  
  METHODS
  Eleven patients with huge aortic aneurysms (>80 mm) and/or acute-subacute ascending aorta dissections underwent surgery with totally axilloaxillary CPB. Short- and midterm outcomes, including survival and complications relating to axilloaxillary cannulation, were reported.
  
  
  RESULTS
  All attempts at axillary artery cannulation were successful. Ten of the 11 axillary vein cannulation attempts were successful, and the target pump flow was achieved via the axillary vein alone. Postoperatively, clinical examinations revealed no cases of arm ischemia or compartment syndrome. Three patients (27.3%) experienced ipsilateral brachial plexus neuropathy that produced right hand weakness. The neuropathy was transient in 2 patients, and the symptoms resolved completely. Hospital death occurred in 1 (9.1%) of the 11 patients. The mean (±SD) follow-up time was 956 ± 292 days. One of the survivors died on postoperative day 105 from subacute graft infection and sepsis. The right arms of all 9 of the living patients were examined physically and by Doppler ultrasonography. We found a chronic recanalized thrombotic change in the subclavian vein in 1 patient (11.1%), who had no complaints.
  
  
  CONCLUSIONS
  Axilloaxillary CPB is an alternative technique that can be used under certain conditions. Adding axillary venous cannulation to axillary artery cannulation at least does not increase the risk of a procedure that uses the axillary artery alone, either in the early or mid term.
authors.affiliation: Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Altug
authors.initials: A
authors.lastname: Tuncer
authors.forename: Taylan
authors.initials: T
authors.lastname: Adademir
authors.forename: Eylem
authors.initials: E
authors.lastname: Tuncer
authors.forename: Serpil Gezer
authors.initials: SG
authors.lastname: Tas
authors.forename: Arzu Antal
authors.initials: AA
authors.lastname: Donmez
authors.forename: Hasan
authors.initials: H
authors.lastname: Sunar
authors.forename: Mehmet
authors.initials: M
authors.lastname: Balkanay
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001366:Axillary Artery; D001367:Axillary Vein; D002315:Cardiopulmonary Bypass / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014463:Ultrasonography; D055815:Young Adult