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Eur J Cardiothorac Surg 2003;23:771-775
© 2003 Elsevier Science NL

Total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion

^a Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
^b Department of Thoracic Surgery, Fujita Health University, Nagoya, Japan

Received 30 September 2002; received in revised form 31 January 2003; accepted 4 February 2003.

^* Corresponding author. Tel.: +81-6-6833-5012; fax: +81-6-6872-7486
e-mail: hogino{at}hsp.ncvc.go.jp

Objective: Right axillary artery (AxA) perfusion, which can prevent cerebral embolism caused by retrograde perfusion via the femoral artery (FA), was used for selective cerebral perfusion (SCP) as well as cardiopulmonary bypass (CPB) in aortic arch repair. We review the outcome of aortic arch surgery using SCP with right AxA perfusion to clarify its efficacy. Method: Between 1998 and 2002, 120 patients underwent aortic arch repair using SCP with right AxA perfusion. The mean age was 69±10 years. Aneurysms were atherosclerotic in 79, dissecting in 32, and others in nine patients. Twenty of them (16.7%) required emergency surgery. CPB was initiated with right AxA and FA perfusion, and following SCP was established using right AxA and left common carotid artery perfusion. Results: With right AxA perfusion, hospital mortality was 5.8%. Multivariate analysis showed only ruptured aneurysm was an independent determinant for hospital mortality. Permanent neurological dysfunction developed in one patient (0.8%), while seven (5.8%) suffered from temporary one. In univariate analysis, SCP time, stenosis of the carotid arteries, past history of cerebrovascular events, and atherosclerotic aneurysm were not related to temporary neurological deficits Conclusion: Right AxA perfusion in conjunction with SCP is a safe and useful alternative for brain protection in total arch replacement.

Key Words: Aortic arch replacement • Selective cerebral perfusion • Neurological dysfunction • Axillary artery perfusion

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