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Clinical Result of Aortic Arch Replacement using Antegrade Brain Perfusion Via Right Axillary Artery  

Kim, Dong-Jin (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Na, Yong-Jun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Jeong, Dong-Seop (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Kim, Kyung-Hwan (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Chest Surgery / v.40, no.1, 2007 , pp. 25-31 More about this Journal
Abstract
Background: Cerebral protection is one of the most important procedures during aortic arch surgery. We can minimize neurological complications through short period of total circulatory arrest and resuming of brain perfusion. We evaluated 11 patients who underwent arch replacement using antegrade brain perfusion via right axillary artery. Material and Method: Between July 2004 and July 2006, 11 patients (male 9, female 2) underwent aortic arch replacement with antegrade brain perfusion via right axillary artery. Preoperative diagnosis was listed; 5 type A aortic dissections (5/11, 45.5%), 5 aortic aneurysms (5/11, 45,5%) and 1 type A IMH (intramural hematoma, 1/11, 9%). The mean age at the time of operation was $60.3{\pm}12.8$ years. For antegrade brain perfusion, we performed right axillary artery cannulation in all patients. Retrograde brain perfusion was used briefly during total circulatory arrest. Result: The mean total circulatory arrest time was $31.1{\pm}16.9$ minutes and the mean retrograde brain perfusion time was $21{\pm}17.8$ minutes. Mean antegrade brain perfusion time was $77.9{\pm}17.5\;(43{\sim}101)$ minutes. We had neither operative mortality nor permanent neurological complications. Conclusion: By means of antegrade brain perfusion via right axillary artery, that could lead to decrease circulatory arrest time and minimize damages to severely atheromatous arch vessels, we can expect to reduce neurological complications after aortic arch replacement. Further investigation with iarge patient populations will be required.
Keywords
Aorta, arch; Perfusion, antegrade; Axillary artery;
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1 Spielvogel D, Strauch JT, Minanov OP, Lansman SL, Griepp RB. Aortic arch replacement using a trifurcated graft and selective cerebral antegrade perfusion. Ann Thorac Surg 2002;74:S1810-4   DOI   ScienceOn
2 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   PUBMED
3 Nishimura M, Ohtake S, Sawa Y, et al. Arch-first technique for aortic arch aneurysm repair through median sternotomy. Ann Thorac Surg 2002;74:1264-6   DOI   ScienceOn
4 Sasaki M, Usui A, Yoshikawa M, Akita T, Ueda Y. Archfirst technique performed under hypothermic circulatory arrest with retrograde cerebral perfusion improves neurological outcomes for total arch replacement. Eur J Cardiothorac Surg 2005;27:821-5   DOI   ScienceOn
5 Kazui T, Yamashita K, Washiyama N, et al. Usefulness of antegrade selective cerebral perfusion during aortic arch operation. Ann Thorac Surg 2002;74(suppl):S1806-9   DOI   ScienceOn
6 Frist WH, Baldwin JC, Starnes VA, et al. A reconsideration of cerebral perfusion in aortic arch replacement. Ann Thorac Surg 1986;42:273-81   DOI   PUBMED   ScienceOn
7 Dossche KM, Schepens MAAM, Morshuis WJ, Muysoms FE, Langemeijer JJ, Vermeulen FEE. Antegrade selective cerebral perfusion in operations on the proximal thoracic aorta. Ann Thorac Surg 1999;67:1904-10   DOI   ScienceOn
8 Usui A, Yasuura K, Watanabe T, Maseki T. Comparative clinical study between retrograde cerebral perfusion and selective cerebral perfusion in surgery for acute type A aortic dissection. Eur J Cardiothorac Surg 1999;15:571-8   DOI   ScienceOn
9 Cho KJ, Woo JS, Kim SH, Bang JH, Lee GS, Choi PJ. The short term results of the total aortic arch replacement with arch first technique. Korean J Thorac Cardiovasc Surg 2004; 37:903-10
10 Usui A, Abe T, Murase M. Early clinical results of retrograde cerebral perfusion for aortic arch surgery in Japan. Ann Thorac Surg 1996;62:94-104   DOI   ScienceOn
11 Wozniak G, Dapper F, Schindler E, et al. An assessment of selective cerebral perfusion via the innominate artery in aortic arch replacement. Thorac Cardiovasc Surg 1998;46: 7-11   DOI   ScienceOn
12 Estrera AL, Miller III CC, Huynh TTT, Porat EE, Safi HJ. Replacement of the ascending and transverse aortic arch: determinants of long-term survival. Ann Thorac Surg 2002; 74:1058-65   DOI   ScienceOn
13 Ueda T, Shimizu H, Ito T, et al. Cerebral complications associated with selective perfusion of the arch vessel. Ann Thoracic Surg 2000;70:1472-7   DOI   ScienceOn
14 Svensson L, Crawford ES, Heso KR, et al. Deep hypothermia circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg 1993;106:19-31   PUBMED
15 Kouchoukos NT, Masetti P, Rokkas CK, Murphy SF. Singlestage reoperative repair of chronic type A aortic dissection by means of the arch-first technique. J Thorac Cardiovasc Surg 2001;122:578-82   DOI   ScienceOn
16 Rokkas CK, Kouchoukos NT. Single-stage extensive replacement of the thoracic aorta: the arch-first technique. J Thorac Cardiovasc Surg 1999;117:99-105   DOI   ScienceOn
17 Yoshimura N, Okada M, Ota T, Nohara H. Pharmacologic intervention for ischemic brain edema after retrograde cerebral perfusion. J Thorac Cardiovasc Surg 1995;109:1173-81   DOI   ScienceOn