Abstract
Background
We examined the effectiveness of right axillary arterial perfusion through an interposed Dacron graft in the prevention of cerebral embolism or complications related to ascending aortic cannulation in open proximal anastomosis technique of descending thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) repair under deep hypothermic circulatory arrest through left thoracotomy.
Methods
Between May 2000 and August 2012, 44 patients underwent TAA or TAAA repair using open proximal technique under DHCA. These patients were divided into two groups for evaluation of the effectiveness of right axillary arterial perfusion. Group A included patients who underwent TAA or TAAA repair with ascending aortic cannulation (n = 15). Group B was composed of patients who had TAA or TAAA repair with right axillary arterial perfusion through the interposed Dacron graft (n = 29).
Results
Mortality in this series was 4.5 % (2 of 44 patients; 1 in each group); wherein, the causes were sepsis due to graft infection and aortic dissection (Stanford type A). The incidence rates of cerebral embolism were 27 % (4 of 15 patients in group A) and 3.4 % (1 of 29 patients in group B) (p = 0.0392, Fisher’s exact test). The rates of complications in relation to the aortic cannulation site (dissection or bleeding) were 13 % (2 of 15 patients in group A) and 0 % (0 of 25 patients in group B).
Conclusions
Right axillary perfusion facilitates easy evacuation of air and allows prompt recommencement of upper body circulation. Consequently, it minimizes the risk of cerebral embolism or complications in relation to aortic cannulation through left thoracotomy.
Similar content being viewed by others
References
Sabik JF, Lytle BW, McCarthy PM, Cosgrove DM. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg. 1995;109:885–90.
Coletti G, Torracca L, La Canna G, Maisano F, Sebastiano P, Fucci C, et al. Diagnosis and management of cerebral malperfusion phenomena during aortic dissection repair by transesophageal Doppler echocardiographic monitoring. J Card Surg. 1996;11:355–8.
Westaby S, Katsumata T. Proximal aortic perfusion for complex arch and descending aortic disease. J Thorac Cardiovasc Surg. 1998;115:162–7.
Mieno S, Ozawa H, Daimon M, Hamori K, Sasaki T, Woo E, et al. Minimizing cerebral embolism in resection of distal aortic arch aneurysm through a left thoracotomy. Ann Thorac Surg. 2011;91:472–7.
Ergin MA, Galla JD, Lansman SL, Quintana C, Bodian C, Griepp RB. Hypothermic circulatory arrest in operations on the thoracic aorta. Determinants of operative mortality and neurologic outcome. J Thorac Cardiovasc Surg. 1994;107:788–99.
Takamoto S, Okita Y, Ando M, Morota T, Handa N, Kawashima Y. Retrograde cerebral circulation for distal aortic arch surgery through a left thoracotomy. J Card Surg. 1994;9:576–83.
Corvera JS, Fehrenbacher JW. Open repair of chronic aortic dissections using deep hypothermia and circulatory arrest. Ann Thorac Surg. 2012;94:78–81 (discussion 82–3).
Fehrenbacher JW, Hart DW, Huddleston E, Siderys H, Rice C. Optimal end-organ protection for thoracic and thoracoabdominal aortic aneurysm repair using deep hypothermic circulatory arrest. Ann Thorac Surg. 2007;83:1041–6.
Reich DL, Uysal S, Ergin MA, Griepp RB. Retrograde cerebral perfusion as a method of neuroprotection during thoracic aortic surgery. Ann Thorac Surg. 2001;72:1774–82.
Westaby S, Katsumata T, Vaccari G. Arch and descending aortic aneurysms: influence of perfusion technique on neurological outcome. Eur J Cardiothorac Surg. 1999;15:180–5.
Ogino H, Sasaki H, Minatoya K, Matsuda H, Tanaka H, Watanuki H, et al. Evolving arch surgery using integrated antegrade selective cerebral perfusion: impact of axillary artery perfusion. J Thorac Cardiovasc Surg. 2008;136:641–8.
Pacini D, Di Marco L, Marsilli O, Mikus E, Loforte A, Sobaih F, et al. Nine years experience of aortic arch repair with the aid of antegrade selective cerebral perfusion. J Gardiovasc Surg (Torino). 2006;47:691–8.
Bichell DP, Balaguer JM, Aranki SF, Couper GS, Adams DH, Rizzo RJ, et al. Axilloaxillary cardiopulmonary bypass: a practical alternative to femorofemoral bypass. Ann Thorac Surg. 1997;64:702–5.
Tabayashi K, Akimoto K, Niibori K, Iguchi A, Ohmi M, Mohri H. Separate perfusion of upper and lower body for ruptured thoracoabdominal aortic aneurysm: a case report. J Jpn Assoc Thorac Surg. 1992;40:570–3.
Baribeau YR, Westbrook BM, Charlesworth DC, Maloney CT. Arterial inflow via an axillary artery graft for the severely atheromatous aorta. Ann Thorac Surg. 1998;66:33–7.
Shiiya N, Kunihara T, Imamura M, Murashita T, Matsui Y, Yasuda K. Surgical management of atherosclerotic aortic arch aneurysms using selective cerebral perfusion: 7-year experience in 52 patients. Eur J Cardiothorac Surg. 2000;17:266–71.
Conflict of interest
Nobuyoshi Kawaharada and other co-authors have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kawaharada, N., Ito, T., Naraoka, S. et al. Right axillary arterial perfusion for descending thoracic or thoracoabdominal aortic aneurysm repair with open proximal anastomosis through left thoracotomy. Gen Thorac Cardiovasc Surg 62, 547–552 (2014). https://doi.org/10.1007/s11748-014-0404-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-014-0404-z