[Outcome of aortic arch surgery in patients aged 70 years or older: axillary artery cannulation and selective...

Axillary artery cannulation, selective cerebral perfusion and replacement of the ascending and arch aorta with an elephant trunk were evaluated to reduce cerebral complications in aortic arch surgery in patients with aortic aneurysm or aortic dissection involving the aortic arch.

A total of 45 patients(18 with acute A type aortic dissection and 27 with chronic aortic aneurysm involving the aortic arch) aged 70-92 (mean age 74) years underwent total aortic arch replacement from March 1996 to May 2002. There were three operative deaths in patients with acute A type aortic dissection caused by massive cerebral infarction, bleeding and myocardial infarction, and one hospital death of sepsis. Overall in-hospital mortality was 8.9%(16.7% in A type dissection and 3.7% in chronic aneurysm). Operative complications included mediastinitis in four patients(9%), left recurrent laryngeal nerve palsy in eight(18%), and cerebral infarction in four(9%). Three of the patients with cerebral infarction had associated dissection-related cerebral ischemia before surgery. One patient died, and two needed a walking stick. Twelve of 18 patients(67%) with acute A type aortic dissection and 26 of 27 (96%) with chronic aortic aneurysm were discharged on foot.

Axillary artery cannulation, selective cerebral perfusion and replacement of the ascending and arch aorta with an elephant trunk provided satisfactory operative results in elderly patients aged 70 years or older, especially in patients with chronic aortic aneurysm involving the aortic arch.