Cor Vasa 2009, 51(7-8):491-498 | DOI: 10.33678/cor.2009.124

Advantages of right axillary artery cannulation in surgical management of thoracic aorta dissection involving the aortic arch

Jaroslav Gaj^1,*, Radim Brát¹, Martin Kolek¹, Tomáš Daněk¹, Dana Šalounová²

¹ Kardiochirurgické centrum, Fakultní nemocnice Ostrava

² Katedra matematiky, Ekonomická fakulta, Vysoká škola báňská - Technická univerzita, Ostrava, Česká republika

Objective: The objective of the study was to evaluate the outcome of surgical management of Stanford A type acute and chronic dissections of the thoracic aorta requiring intervention in the aortic arch.

Material and methods: A total of 86 consecutive patients were divided into two groups by the technique of extracorporeal circulation and type of brain protection. Access to extracorporeal circulation obtained from the common femoral artery was used in 42 patients. Deep hypothermic circulatory arrest, and deep hypothermic circulatory arrest combined with selective antegrade cerebral perfusion were utilized for brain protection. Average hypothermia was 18.9 ± 2.8°C; there were 69% of men and 31% of women with a mean age of 63.4 ± 12.3 years. In the other group, consisting of 44 patients, access to extracorporeal circulation was obtained via the right axillary artery. Moderate hypothermic circulatory arrest at 23.7 ± 2.3°C with antegrade cerebral perfusion utilized the right axillary artery approach to protect the brain. Mean age of the group of patients, including 66% of men and 34% of women, was 59.5 ± 14.1 years.

Results: Postoperative blood loss was significantly heavier in the first group (1 719 vs 1 176 ml; p = 0.045). Hospital stay was shorter in the first group (15.8 vs 18.9 days; p = 0.051). However, significantly more patients from the second group were discharged to receive home care (45.2 vs 66.0%; p = 0.054). Transient and permanent neurological dysfunction was present in the same numbers of patients in both groups. Overall in-hospital mortality was lower in the second group (26.1 vs 18.2%; NS), mortality of patients with acute dissection was likewise lower in the second group (25.0 vs 14.7%; NS).

Conclusion: Cannulation of the right axillary artery from separate incisions is a useful technique in aortic arch surgery when treating acute and chronic dissection of the thoracic aorta. Advantages of this approach include antegrade blood flow in extracorporeal circulation as well as antegrade cerebral perfusion.

Keywords: Aortic arch dissection; Brain protection; Right axillary artery

Published: July 1, 2009  Show citation