[Outcomes after total arch replacement using antegrade selective cerebral perfusion under right axillary artery...

Although the outcomes of total arch replacement have been improving, the prevention of cerebral infarction is still an important consideration in aortic arch surgery. Herein, we reviewed our experience with total arch replacement using antegrade selective cerebral perfusion under right axillary artery perfusion. Between January 2002 and March 2013, total arch replacement was performed for 125 patients including 31 patients with acute aortic dissection. An 8 mm polyester grafts was sutured to the axillary artery through the right subclavicular incision and was connected to cardiopulmonary bypass circuit. Antegrade selective cerebral perfusion under hypothermic circulatory arrest was initiated using right axillary artery perfusion. Postoperative cerebral infarction occurred in 5.6% of patients. Hospital mortality rate was 3.2%. The 5-year rate of freedom from aortic event was 83%. The 5-year survival rate was 75%. We consider that right axillary artery perfusion is advantageous for preventing cerebral infarction in total arch replacement.