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General Thoracic and Cardiovascular Surgery

Published in:

01-09-2014 | Original Article

Right axillary arterial perfusion for descending thoracic or thoracoabdominal aortic aneurysm repair with open proximal anastomosis through left thoracotomy

Authors: Nobuyoshi Kawaharada, Toshiro Ito, Shuichi Naraoka, Takayuki Hagiwara, Tetsuya Koyanagi, Yoshihiko Kurimoto, Tetsuya Higami

Published in: General Thoracic and Cardiovascular Surgery | Issue 9/2014

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.

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Title: Right axillary arterial perfusion for descending thoracic or thoracoabdominal aortic aneurysm repair with open proximal anastomosis through left thoracotomy
Authors: Nobuyoshi Kawaharada
Toshiro Ito
Shuichi Naraoka
Takayuki Hagiwara
Tetsuya Koyanagi
Yoshihiko Kurimoto
Tetsuya Higami
Publication date: 01-09-2014
Publisher: Springer Japan
Published in: General Thoracic and Cardiovascular Surgery / Issue 9/2014
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-014-0404-z

At a glance: The STEP trials

Springer Medicine

Right axillary arterial perfusion for descending thoracic or thoracoabdominal aortic aneurysm repair with open proximal anastomosis through left thoracotomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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