Axillary artery perfusion in acute aortic dissection type a repair for a better cerebral protection

05.04.2006, 16:45

Articol din publicatia Revista Societatii Romane de Chirurgie nr. 1/2003
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M. Gaspar
Cardiac Surgery Department, University Hospital of Surgery, Innsbruck, Austria

J. Bonatti, L. Müller, H. Antretter, G. Laufer
Cardiac Surgery Department

Background: The best methods for cerebral and visceral protection during complex repairs of aortic arch in case of dissection and aneurysms is still not clear. The purpose of our study was to evaluate and compare the advantages and complication of axillary, providing antegrade flow and femoral cannulation, providing retrograde perfusion, in specific cases of acute dissection. Methods: We started, in July 2000, to apply axillary artery cannulation achieving full cardiopulmonary bypass. Between January 1991 and September 2001, 67 emergency patients underwent aortic repair for acute aortic dissection type A, using deep hypothermia and total circulatory arrest. Axillary cannulation 14 (21%) patients, femoral cannulation 52 (77%), and cannulation via ascending aorta 1 (2%).

Results: Overall hospital mortality was 8/52 in the femoral and 1/14 in the axillary cannulation group. Postoperatively we observed no occurrence of neurologic events, no revision for postoperative bleeding, a lower incidence of sepsis and low cardiac output syndrome in the axillary artery cannulation group. In comparison to the femoral artery group we had 7,5 % neurologic events, 23% MSOF, 17% sepsis, 28% postoperative bleeding and 26% new renal failure.

Conclusion: On the basis of our results we conclude that axillary cannulation is a promising approach for acute aortic dissection. Primarily to prevent neurological events. Nevertheless further investigations are necessary.

Chirurgia (Buc.) 2003, 1, 98:37-41

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