Clinical ResearchInnominate and Axillary Cannulation in Aortic Arch Surgery Provide Similar Neuroprotection
Section snippets
Methods
Between January 2008 and May 2015, 140 consecutive patients underwent elective aortic hemiarch reconstruction with circulatory arrest, at 2 separate institutions (London Health Sciences Centre, London, Ontario, Canada, and St Michael's Hospital, Toronto, Ontario, Canada). Patients who underwent aortic root and valve procedures were included in the current investigation, along with patients who underwent all other concomitant procedures. The axillary cannulation group included 74 patients (mean
Whole group analysis
Preoperative patient characteristics were similar between the 2 groups with the exception of older age in the axillary group and a higher incidence of peripheral vascular disease in the axillary group (Table 1). A greater proportion of patients in the in the axillary group underwent valve-sparing root replacements (16.2%) compared with the innominate group (4.5%; P = 0.030). Patients in the axillary group also had more concomitant procedures than those in the innominate group (axillary 21.6%,
Discussion
Delivery of continuous ACP through an axillary artery side graft provides excellent neuroprotection and allows for circulatory arrest with moderate hypothermia during aortic arch surgery.11, 12 Although this perfusion strategy is favoured by many groups worldwide, axillary artery cannulation has been associated with some risk of brachial plexus injuries, arm ischemia, arm hyperperfusion, and seroma formation.6, 7, 8, 13, 14 Moreover, axillary artery cannulation requires an additional incision,
Disclosures
M.W.C. is a consultant to Medtronic, Canada and Edwards Lifesciences. The other authors have no conflicts of interest to declare.
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