Comparison of Two Right Axillary Artery Perfusion Methods for Stanford Type A Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIA Zaishen , ZHANG Huiping , XU Weimin

1.Department of Extracorporeal Circulation，Anzhen Hospital， Capital Medical University Beijing ，Beijing 100029， P.R.China;;
2. Department of Anesthesiology， 452 Hospital of PLA ，Chengdu 610021，P.R.China;

Corresponding author：

Keywords：

Aortic dissection; Deep hypothermic circulatory arrest; Antegrade cerebral perfusion; Axillary artery cannulation

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Abstract： Objective To evaluate the clinical safety and neurological outcomes of right axillary artery cannulation with a side graft compared with a direct approachin aortic arch replacement for patients with acute Stanford type A aortic dissection. Methods Between July 2008 and July 2010， 280 consecutive patients with acute Stanford type A aortic dissection underwent right axillary artery cannulation for cardiopulmonary bypass （CPB） in total arch replacement and stented “elephant trunk” implantation in our hospital.These 280 patients were divided into two groups according to the method of axillary artery cannulation in operation:direct arterial cannulation was used in 215 patients（direct arterial cannulation
group， DG group， mean age of 43.1±9.5 years）， while cannulation with a side graft was used in 65 patients（ indirect cannulation group， IG group， mean age of 44.7±8.3 years）. Clinical characteristics of both groups were similar except their axillary artery cannulation method. Patient outcomes were compared as to the prevalence of clinical complications， especially neurological deficits and postoperative morbidity. Results The overall hospital mortality was 3.6% （10/280）， 3.3% （7/215） in DG group and 4.6% （3/65） in IG group respectively.Right axillary artery cannulation was successfully performed in all cases without any occurrence of malperfusion. Postoperatively， 25 patients（8.9%）developed temporary
neurological deficits， 19 cases in DG group（8.8%）， and 6 cases in IG group （9.2%）， and all these patients were cured after treatment. The incidence of postoperative complications directly related to axillary artery cannulation was significantly lower in IG group than that in DG group（1 case vs. 19 cases， P=0.045）. There were no statistical differences in arterial perfusion peak flow， peak pressure，antegrade cerebral perfusion time， deep hypothermic circulatory arrest time， and CPB time between the two groups（P ＞ 0.05）. Conclusion Right axillary artery cannulation with a side graftcan significantly reduce the postoperative complications of axillary artery cannulation. It is a safe and effective method for patients undergoing surgery for acute Stanford type A aortic dissection.

Citation： JIA Zaishen,ZHANG Huiping,XU Weimin,et al .. Comparison of Two Right Axillary Artery Perfusion Methods for Stanford Type A Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(1): 26-30. doi: Copy

1.	Kazui T，Yamashita K，Washiyama N，et al．Aortic arch replacement using selective cerebral perfusion. Ann Thorac Surg ，2007， 83（2）：S796-S798.
2.	Harrington DK，Fragomeni F，Bonser RS.Cerebral perfusion. Ann Thorac Surg，2007，83（2）：S799-804.
3.	Gulbins H，Pritisanac A，Ennker J，et al．Axillary versus femoral cannulation for aortic surgery： enough evidence for a general recommendation? Ann Thorac Surg，2007，83 （3）：1219-1224.
4.	肖正华，张尔永，郭应强，等. 腋动脉侧接人工血管插管法在深低温停循环手术中的应用. 中国胸心血管外科临床杂志，2010，17（1）：60-61.
5.	Siminelakis SN，Baikoussis NG，Papadopoulos GS，et al．Axillary artery cannulation for cardiopulmonary bypass during surgery on the ascending aorta and arch. J Card Surg，2009，24 （3）：301-304.
6.	Kano M，Chikugo F，Shimahara Y，et al．Left axillary artery perfusion in surgery of type A aortic dissection.Ann Thorac Cardiovasc Surg，2008，14（1）：22-24.
7.	Schachner T，Nagiller J，Zimmer A，et al．Technical problems and complications of axillary artery cannulation. Eur J Cardiothorac Surg, 2005，27 （4）：634-637.
8.	Svensson LG，Blackstone EH，Rajeswaran J，et al．Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg，2004，78 （4）：1274-1284.
9.	Küçüker SA，Ozatik MA，Saritas A，et al．Arch repair with unilateral antegrade cerebral perfusion. Eur Cardiothoracic Surg，2005，27（4）：638-643.
10.	Sabik JF，Nemeh H，Lytle BW，et al.Cannulation of the axillary artery with a side graft reduces morbidity.Ann Thorac Surg，2004，77 （4）：1315-1320.
11.	Minatoya K， Ogino H， Matsuda H， et al．Evolving selective cerebral perfusion for aortic arch replacement： high flow rate with moderate hypothermic circulatory arrest. Ann Thorac Surg，2008，86 （6）：1827-1831.
12.	Takayama H，Smith CR，Bowdish ME，et al．Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia．J Thorac Cardiovasc Surg，2009，137 （6）： 1450-1453.

1. Kazui T，Yamashita K，Washiyama N，et al．Aortic arch replacement using selective cerebral perfusion. Ann Thorac Surg ，2007， 83（2）：S796-S798.
2. Harrington DK，Fragomeni F，Bonser RS.Cerebral perfusion. Ann Thorac Surg，2007，83（2）：S799-804.
3. Gulbins H，Pritisanac A，Ennker J，et al．Axillary versus femoral cannulation for aortic surgery： enough evidence for a general recommendation? Ann Thorac Surg，2007，83 （3）：1219-1224.
4. 肖正华，张尔永，郭应强，等. 腋动脉侧接人工血管插管法在深低温停循环手术中的应用. 中国胸心血管外科临床杂志，2010，17（1）：60-61.
5. Siminelakis SN，Baikoussis NG，Papadopoulos GS，et al．Axillary artery cannulation for cardiopulmonary bypass during surgery on the ascending aorta and arch. J Card Surg，2009，24 （3）：301-304.
6. Kano M，Chikugo F，Shimahara Y，et al．Left axillary artery perfusion in surgery of type A aortic dissection.Ann Thorac Cardiovasc Surg，2008，14（1）：22-24.
7. Schachner T，Nagiller J，Zimmer A，et al．Technical problems and complications of axillary artery cannulation. Eur J Cardiothorac Surg, 2005，27 （4）：634-637.
8. Svensson LG，Blackstone EH，Rajeswaran J，et al．Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg，2004，78 （4）：1274-1284.
9. Küçüker SA，Ozatik MA，Saritas A，et al．Arch repair with unilateral antegrade cerebral perfusion. Eur Cardiothoracic Surg，2005，27（4）：638-643.
10. Sabik JF，Nemeh H，Lytle BW，et al.Cannulation of the axillary artery with a side graft reduces morbidity.Ann Thorac Surg，2004，77 （4）：1315-1320.
11. Minatoya K， Ogino H， Matsuda H， et al．Evolving selective cerebral perfusion for aortic arch replacement： high flow rate with moderate hypothermic circulatory arrest. Ann Thorac Surg，2008，86 （6）：1827-1831.
12. Takayama H，Smith CR，Bowdish ME，et al．Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia．J Thorac Cardiovasc Surg，2009，137 （6）： 1450-1453.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of Two Right Axillary Artery Perfusion Methods for Stanford Type A Aortic Dissection

Abstract Full text Figures/Tables Video References Cited by

Format

Content