| Title | Evolving arch surgery using integrated antegrade selective cerebral perfusion: impact of axillary artery perfusion. | | Author(s) | Ogino H, Sasaki H, Minatoya K, Matsuda H, Tanaka H, Watanuki H, Ando M, Kitamura S | | Institution | Department of Cardiovascular Surgery, National Cardiovascular Center, Aichi, Japan. hogino@hsp.ncvc.go.jp | | Source | J Thorac Cardiovasc Surg 2008 Sep; 136(3):641-8; discussion 948-9. | | MeSH | Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting
Aorta, Thoracic
Aortic Aneurysm, Thoracic
Axillary Artery
Cardiopulmonary Bypass
Cerebrovascular Circulation
Circulatory Arrest, Deep Hypothermia Induced
Female
Humans
Male
Middle Aged
Perfusion
Retrospective Studies
Treatment Outcome
Vascular Surgical Procedures
| | Abstract | OBJECTIVE: The study objective was to determine the impact of integrated antegrade selective cerebral perfusion with right axillary artery perfusion during arch surgery.
METHODS: All surgeries were performed through a median sternotomy. Direct cannulation of the right axillary artery in the axilla was used for cardiopulmonary bypass and antegrade selective cerebral perfusion under hypothermia. In addition, ascending aortic or femoral artery perfusion was used. The clinical records of 531 patients (median age, 72 years) between 1999 and 2006 were reviewed, of whom 137 patients (25.8%) underwent emergency surgery. There were 164 dissecting and 367 nondissecting aortic lesions. The surgeries included total arch replacement in 431 patients, partial arch replacement in 9 patients, and hemiarch replacement in 91 patients.
RESULTS: The early mortality rate was 4.0% (2.3% of 30-day mortality and 1.7% of in-hospital mortality). The incidence of permanent neurologic dysfunction was 2.9% in all (3.3% in total arch replacement and 1.0% in hemiarch or partial arch replacement). The incidence of temporary dysfunction was 9.9% in all (10.6% in total arch replacement and 7.0% in hemiarch or partial arch replacement). Multivariate analysis demonstrated that the risk factors for early mortality were chronic renal failure, ruptured nondissecting aneurysm, and prolonged surgery. The midterm survival was 87.2% +/- 1.7% at 3 years and 80.5% +/- 2.6% at 5 years.
CONCLUSION: Right axillary artery perfusion is an advantageous adjunct to cardiopulmonary bypass and antegrade selective cerebral perfusion in arch surgery. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 18805266 |
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