Perfusion Pressure Does Not Affect Neurologic Outcome in Axillary Artery Side Graft Cannulation in Type A Aortic Dissection
DOI:
https://doi.org/10.1532/HSF98.20061038Abstract
Objective. Antegrade selective cerebral perfusion (ASCP) through the right axillary is a safe and effective method for cerebral protection in aortic surgery. In the present study, we evaluated whether or not pressure control in ASCP affected the neurologic outcome.
Method. Sixty-two patients (17 female, 45 male) with a mean age of 53.9 ± 9.4 years (range, 23-74 years) with a diagnosis of Type A aortic dissection were operated on by using the right axillary artery side graft cannulation technique. ASCP with pressure control was used in the first 37 (59.6%) patients (group 1), whereas ASCP with flow control was used in the consecutive 25 patients (39.4%) (group 2). The groups were compared according to postoperative neurologic outcomes.
Results. The hospital mortality rate was 9.7% with 6 patients. The mean ASCP flows of group 1 was 663 ± 76 mL/min and 692 ± 51 mL/min in group 2. This difference was not statistically significant (P = .120). The neurological dysfunction rates were 2.7% in group 1 with 1 patient and 8% in group 2 with 2 patients (P = .560).
Conclusion. In this study, we could not find a statistically significant difference in patients treated with ASCP through the right axillary applicated with pressure control versus flow control.
References
Borst HG. 1995. Axillary artery for extracorporeal circulation. J Thorac Cardiovasc Surg 110:1775.nBorst HG. 1996. In: Borst HG, Heinemann MK, Stone CD, eds. Surgical Treatment of Aortic Dissection. 1st ed. New York, NY: Churchill Livingstone; 255-68.nNeri E, Massetti M, Capannini G, et al. 1999. Axillary artery cannulation in type A aortic dissection operations. J Thorac Cardiovasc Surg 118:324-9.nSabik JF, Lytle BW, McCarthy PM, Cosgrove DM. 1995. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg 109:885-91.nShekar PS, Ehsan A, Gilfeather MS, Lekowski RW Jr, Couper GS. 2005. Arterial pressure monitoring during cardiopulmonary bypass using axillary arterial cannulation. J Cardiothorac Vasc Anesth 19:665-6.nSnell RS. 1992. The Head and Neck. Clinical Anatomy for Medical Students. Fourth ed. Boston, MA: Little, Brown and Company; 823-5.nStrauch JT, Spielvogel D, Lauten A, et al. 2004. Axillary artery cannulation: routine use in ascending aorta and aortic arch replacement. Ann Thorac Surg 78:103-8.nSvensson LG. 2002. Antegrade perfusion during suspended animation. J Thorac Cardiovasc Surg 124:1068-70.nWhitlark JD, Goldman SM, Sutter FP. 2000. Axillary artery cannulation in acute ascending aortic dissections. Ann Thorac Surg 69:1127-9.nYavuz S, Göncü MT, Türk T. 2002. Axillary artery cannulation for arterial inflow in patients with acute dissection of the ascending aorta. Eur J Cardiothorac Surg 22:313-5.n
