Bilateral Axillary Artery Perfusion in Total Arch Replacement.

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Arterial cannulation site is critical for preventing cerebral infarction in total arch replacement surgery.
• Comparison of outcomes between bilateral axillary artery, femoral artery, and central cannulation is essential.

Purpose of the Study:

• To compare the outcomes of total arch replacement using different arterial cannulation sites.
• To evaluate the efficacy of bilateral axillary artery cannulation in preventing cerebral infarction.

Main Methods:

• A study of 242 patients undergoing total arch replacement, divided into three groups based on cannulation site: bilateral axillary artery (124 patients), femoral artery (88 patients), and central (30 patients).
• Selective cerebral perfusion was employed for brain protection in all participants.
• Surgical outcomes, including postoperative cerebral infarction, were analyzed and compared across groups.

Main Results:

• The bilateral axillary artery group demonstrated significantly shorter cardiopulmonary bypass and lower-body circulatory arrest times.
• The incidence of permanent neurologic deficit was significantly lower in the bilateral axillary artery group (0.8%) compared to the central cannulation group (13%).
• Bilateral axillary artery perfusion was identified as a significant factor in preventing permanent neurologic deficit (odds ratio 0.10, P = .03).

Conclusions:

• Technical advancements, including bilateral axillary artery perfusion and the frozen elephant trunk technique, are linked to reduced cardiopulmonary bypass time.
• These techniques are associated with the prevention of postoperative cerebral infarction in patients undergoing total arch replacement.