• Hitoshi Ogino, Hiroaki Sasaki, Kenji Minatoya, Hitoshi Matsuda, Hiroshi Tanaka, Hirotaka Watanuki, Motomi Ando, and Soichiro Kitamura.
• Department of Cardiovascular Surgery, National Cardiovascular Center, Aichi, Japan. hogino@hsp.ncvc.go.jp
• J. Thorac. Cardiovasc. Surg. 2008 Sep 1;136(3):641-8; discussion 948-9.

ObjectiveThe study objective was to determine the impact of integrated antegrade selective cerebral perfusion with right axillary artery perfusion during arch surgery.MethodsAll surgeries were performed through a median sternotomy. Direct cannulation of the right axillary artery in the axilla was used for cardiopulmonary bypass and antegrade selective cerebral perfusion under hypothermia. In addition, ascending aortic or femoral artery perfusion was used. The clinical records of 531 patients (median age, 72 years) between 1999 and 2006 were reviewed, of whom 137 patients (25.8%) underwent emergency surgery. There were 164 dissecting and 367 nondissecting aortic lesions. The surgeries included total arch replacement in 431 patients, partial arch replacement in 9 patients, and hemiarch replacement in 91 patients.ResultsThe early mortality rate was 4.0% (2.3% of 30-day mortality and 1.7% of in-hospital mortality). The incidence of permanent neurologic dysfunction was 2.9% in all (3.3% in total arch replacement and 1.0% in hemiarch or partial arch replacement). The incidence of temporary dysfunction was 9.9% in all (10.6% in total arch replacement and 7.0% in hemiarch or partial arch replacement). Multivariate analysis demonstrated that the risk factors for early mortality were chronic renal failure, ruptured nondissecting aneurysm, and prolonged surgery. The midterm survival was 87.2% +/- 1.7% at 3 years and 80.5% +/- 2.6% at 5 years.ConclusionRight axillary artery perfusion is an advantageous adjunct to cardiopulmonary bypass and antegrade selective cerebral perfusion in arch surgery.

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