Minimized mortality and neurological complications in surgery for chronic arch aneurysm: axillary artery cannulation, selective cerebral perfusion, and replacement of the ascending and total arch aorta

Cerebral complication is still a major concern in surgery for arteriosclerotic aortic arch disease. For preventing this complication, axillary artery cannulation, selective cerebral perfusion, and replacement of the ascending and arch aorta were applied to thoracic aortic aneurysm involving aortic a...

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Bibliographic Details
Published in:Journal of cardiac surgery 2004-07, Vol.19 (4), p.338-342
Main Authors: Shimazaki, Yasuhisa, Watanabe, Takao, Takahashi, Toshiki, Minowa, Takashi, Inui, Kiyoshige, Uchida, Tetsuro, Koshika, Masataka, Takeda, Fumihiro
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting - mortality
Aneurysm, Dissecting - surgery
Aorta, Thoracic - surgery
Axillary Artery
Blood Vessel Prosthesis Implantation - mortality
Cardiopulmonary Bypass
Cerebral Infarction - etiology
Cerebral Infarction - prevention & control
Cerebrovascular Circulation
Chronic Disease
Female
Humans
Male
Middle Aged
Perfusion
Postoperative Complications - prevention & control
Treatment Outcome
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Summary:Cerebral complication is still a major concern in surgery for arteriosclerotic aortic arch disease. For preventing this complication, axillary artery cannulation, selective cerebral perfusion, and replacement of the ascending and arch aorta were applied to thoracic aortic aneurysm involving aortic arch. From May 1999 to July 2002, consecutive 39 patients with true aneurysm (29 patients) or chronic aortic dissection (10 patients) involving aortic arch underwent replacement of the ascending and arch aorta with an elephant trunk under hypothermic cardiopulmonary bypass through the axillary artery cannulation and selective cerebral perfusion. The brain was continuously perfused without any intermission through the axillary artery. Concomitant operation included coronary artery bypass grafting (CABG) in two patients, aortic valve replacement (AVR) in one, Bentall operation in two, mitral valve replacement (MVR) in one, and aortic valve sparing operation in one. Patient age at operation was 40-84 (72 + 9) years and 24 of them were older than 70 years of age. There was one operative death (2.5%) due to bleeding from the left lung, and one hospital death due to respiratory failure. Postoperative permanent neurological dysfunction was found in one patient (2.5%). Two patients presented temporary neurological dysfunction (5%). Thirty-six of the 39 patients were discharged from hospital on foot. Continuous perfusion through the axillary artery with selective cerebral perfusion and replacement of the ascending and arch aorta may minimize cerebral complication leading to satisfactory results in patients with chronic aortic aneurysm involving aortic arch.
ISSN:0886-0440
1540-8191
DOI:10.1111/j.0886-0440.2004.4092_11.x