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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Fujii H., Hirakawa A., Kitazawa Y., Yamamoto T., Nakatani T.
Department of Emergency and Critical Care Medicine Kansai Medical University, Osaka, Japan
Aim. Intraoperative malperfusion caused by arterial perfusion from cardiopulmonary bypass is a lethal complication during surgery of aortic dissection regardless to acute or chronic. The aim of this study was to evaluate the axillary artery as a cardiopulmonary arterial perfusion site in surgery of Stanford type A acute aortic dissection and compare with femoral artery perfusion.
Methods. From June 1992 to March 2005, emergent surgery was performed for 51 patients with Stanford type A acute aortic dissection at Kansai Medical University. This study excluded 17 patients who complicated with acute aortic dissection induced preoperative organ malperfusion, preoperative cardiopulmonary resuscitation, concomitant cardiac operation or chronic obstructive pulmonary disease. This study enrolled 34 patients who underwent surgery using arterial perfusion into the axillary artery (group A: n=21) and into the femoral artery (group B: n=13). In both groups, cardiopulmonary bypass was established by arterial perfusion employing direct cannulation and right atrium drainage.
Results. Between group A and B, there was no significant difference in average age, cardiopulmonary bypass time, circulatory arrest time or operation time. The majority of group A underwent total or partial aortic arch replacement. This induced significantly prolonged aortic cross clamping time in group A. There was no significant difference in postoperative mechanical ventilation time, duration of intensive care unit stay, postoperative hospital stay, hospital death or postoperative complications. No intraoperative malperfusion developed in both groups. Complication associated with axillary arterial perfusion was not occurrence. Myonephropathic metabolic syndrome caused by femoral artery cannulation developed in 1 patient of group B.
Conclusion. Arterial perfusion through axillary artery is suggestible technique that may decrease the risk of complications such as intraoperative malperfusion and myonephropathic metabolic syndrome induced by extremity ischemia.