title: Early and midterm results of transapical and right axillary artery cannulation for acute aortic dissection.
abstract: BACKGROUND
  We combined transapical cannulation and right axillary artery cannulation in the repair of acute type A aortic dissection in order to reduce mortality and morbidity in the presence of risk of malperfusion. Early and midterm outcomes were evaluated.
  
  
  METHODS
  Between October 2009 and March 2012, 23 aortic dissection patients (age, 54.3 ± 13.5 years) received graft replacement using a combination of transapical and right axillary artery cannulation. Preoperative malperfusion was present in 16 patients (69.6%). Cardiopulmonary bypass was initiated with axillary artery cannulation applied via the right axilla and right atrial drainage, then aotric cannulation applied via the left ventricular apex. We retrospectively investigated mortality and morbidity as well as cardiac function, which were evaluated echocardiographically during hospitalization and once a year postoperatively.
  
  
  RESULTS
  All patients received total arch replacement. In-hospital mortality was 4.3%, and no patient developed intraoperative malperfusion. Intraoperative stroke occurred in one patient (4.3%), and three patients (13.0%) suffered from delayed stroke (10-24 days). These delayed strokes might have resulted from cardiogenic thrombus, although no intracardiac thrombus was found. Mean ejection fraction was 66.1 ± 10.9% in the early postoperative period and 73.1 ± 8.7% midterm. There was no left ventricular asynergy or intracardiac thrombus seen on either early or midterm echocardiography.
  
  
  CONCLUSIONS
  Transapical cannulation with right axillary artery cannulation is a safe and effective procedure that can reduce operative risk associated with aortic dissection. Although transapical cannulation does not appear to impair cardiac function, it may confer a risk of delayed stroke.
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. mayfly@shinshu-u.ac.jp.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Terasaki
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. ttakano-ths@umin.ac.jp.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Takano
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. tasutaishi@yahoo.co.jp.
authors.forename: Taishi
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. seto@shinshu-u.ac.jp.
authors.forename: Tatsuichiro
authors.initials: T
authors.lastname: Seto
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. aruko@shinshu-u.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Wada
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. dryoshi@shinshu-u.ac.jp.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ohtsu
authors.affiliation: Department of Cardiovascular Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. kazkom@shinshu-u.ac.jp.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Komatsu
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001366:Axillary Artery; D002315:Cardiopulmonary Bypass / Q000379:methods; D002404:Catheterization / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D016896:Treatment Outcome