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[Total Arch Replacement Using Bilateral Axillary Artery Perfusion].

Mitsuru Yuzaki1, Kentaro Honda, Masahiro Kaneko

  • 1Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|April 8, 2021
PubMed
Summary

Bilateral axillary artery perfusion effectively reduces cerebral complications during total arch replacement (TAR). This technique also facilitates the frozen elephant trunk (FET) procedure, improving surgical outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Cerebral complications are a significant risk during total arch replacement (TAR).
  • The choice of arterial cannulation site is critical for minimizing these risks.
  • Bilateral axillary artery perfusion offers a potential solution for safer TAR.

Purpose of the Study:

  • To evaluate the surgical outcomes of total arch replacement (TAR) using bilateral axillary artery perfusion.
  • To assess the incidence of perioperative cerebral infarction and hospital mortality.
  • To determine the impact of this technique on operative time, particularly with the frozen elephant trunk (FET) procedure.

Main Methods:

  • Retrospective analysis of 97 patients undergoing elective TAR for atherosclerotic aneurysms (January 2012 - June 2020).

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  • 81 patients received bilateral axillary artery perfusion.
  • 34 patients underwent the frozen elephant trunk (FET) procedure, with specific graft reconstruction for the left subclavian artery.

    • Main Results:

    • No perioperative cerebral infarction or hospital deaths were observed.
    • The mean operative time was 420 minutes.
    • The FET procedure significantly reduced operative time to 381 minutes compared to conventional methods.

    Conclusions:

    • Bilateral axillary artery perfusion is associated with reduced cerebral infarction rates in total arch replacement.
    • This perfusion strategy facilitates the performance of the frozen elephant trunk procedure.
    • The technique demonstrates a favorable safety profile and efficiency in complex aortic arch surgery.