Efficacy of Right Axillary Artery Perfusion for Antegrade Cerebral Perfusion in Open Total Arch Repair

OBJECTIVE:

Right axillary artery (RAxA) perfusion was
introduced for selective antegrade cerebral perfusion in total aortic
arch repair to prevent cerebral embolism derived from arterial
cannulation. However, the strategic benefits and long-term results
regarding the cannulation site remain controversial. We retrospectively
compared the outcomes between propensity score-matched patients with and
without using RAxA cannulation.

METHODS:

Between 2006
and 2012, 260 consecutive patients underwent total arch repair with
antegrade cerebral perfusion and moderate hypothermia at a single
institution. RAxA cannulation was added in 142 patients (54.6%), and 70
propensity score-matched pairs were obtained.

RESULTS:

There
were no significant differences in 30-day (2.9% [2 of 70] vs 5.7% [4 of
70]; P = .415 and in-hospital death (5.7% [4 of 70] vs 5.7% [4 of 70];
P = 1.000) between matched pairs. Although there was no significant
difference in the occurrence of postoperative stroke (8.6% [6 of 70] vs
8.6% [6 of 70]; P = 1.000), the new rate of new occurrence
of postoperative paraparesis was lower in patients with RAxA perfusion
(0% [0 of 70] vs 4.3% [3 of 70]; P = .067). With a mean follow-up period
of 1057 ± 686 days, the overall 5-year survival was 90.6% and was 89.6%
for patients with RAxA perfusion. Thee difference in survival between
patients with and without RAxA perfusion was not significant.

CONCLUSIONS:

RAxA
perfusion is a useful option for total aortic arch repair, and the
midterm outcomes were satisfactory. However, RAxA perfusion did not
completely prevent stroke in patients with an atherothrombotic aorta.