title: Efficacy of right axillary artery perfusion for antegrade cerebral perfusion in open total arch repair.
abstract: OBJECTIVE
  Right axillary artery (RAxA) perfusion was introduced for selective antegrade cerebral perfusion in total aortic arch repair to prevent cerebral embolism derived from arterial cannulation. However, the strategic benefits and long-term results regarding the cannulation site remain controversial. We retrospectively compared the outcomes between propensity score-matched patients with and without using RAxA cannulation.
  
  
  METHODS
  Between 2006 and 2012, 260 consecutive patients underwent total arch repair with antegrade cerebral perfusion and moderate hypothermia at a single institution. RAxA cannulation was added in 142 patients (54.6%), and 70 propensity score-matched pairs were obtained.
  
  
  RESULTS
  There were no significant differences in 30-day (2.9% [2 of 70] vs 5.7% [4 of 70]; P = .415 and in-hospital death (5.7% [4 of 70] vs 5.7% [4 of 70]; P = 1.000) between matched pairs. Although there was no significant difference in the occurrence of postoperative stroke (8.6% [6 of 70] vs 8.6% [6 of 70]; P = 1.000), the new rate of new occurrence of postoperative paraparesis was lower in patients with RAxA perfusion (0% [0 of 70] vs 4.3% [3 of 70]; P = .067). With a mean follow-up period of 1057 ± 686 days, the overall 5-year survival was 90.6% and was 89.6% for patients with RAxA perfusion. Thee difference in survival between patients with and without RAxA perfusion was not significant.
  
  
  CONCLUSIONS
  RAxA perfusion is a useful option for total aortic arch repair, and the midterm outcomes were satisfactory. However, RAxA perfusion did not completely prevent stroke in patients with an atherothrombotic aorta.
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan. Electronic address: bassbord1028@yahoo.co.jp.
authors.forename: Arudo
authors.initials: A
authors.lastname: Hiraoka
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Genta
authors.initials: G
authors.lastname: Chikazawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Totsugawa
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshitaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001366:Axillary Artery / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D020766:Intracranial Embolism / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020335:Paraparesis / Q000209:etiology / Q000517:prevention & control; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality