Validity of direct bilateral axillary arterial cannulation in emergency surgery for acute type A aortic dissection

Abstract

Background and Aim of the Study: To assess the validity and long-term outcomes of direct bilateral axillary arterial cannulation for acute type A aortic dissection. Methods: Between 2003 and 2020, 208 consecutive patients with acute type A aortic dissection underwent emergency surgical repair. Cardiopulmonary bypass was attempted to establish direct bilateral axillary arterial cannulation and bicaval drainage. Antegrade selective cerebral perfusion was established by axillary perfusion and direct cannulation of the left common carotid artery.Results: Ascending aortic, partial arch, and extended total aortic arch replacement were performed in 50 (24.0%), 7 (3.4%), and 151 (72.6%) patients, respectively.Aortic root surgery and coronary artery bypass grafting were performed concomitantly in 23 and seven patients, respectively. Cardiopulmonary bypass was attempted only through bilateral axillary cannulation in all patients but was successful in 13 (6.3%) patients without bilateral axillary cannulation. No postoperative complications occurred related to this technique. There were seven hospital deaths (early mortality rate, 3.4%). Five patients had postoperative reoperation for bleeding, and nine (4.3%) were transferred to other hospitals due to postoperative permanent cerebral infarction, particularly two with arm ischemia.The 10-year survival rate of patients who underwent emergency surgical repair with this technique was 71.4%.Conclusions: Direct bilateral axillary arterial cannulation followed by selective cerebral perfusion was successful in 93.7% of patients and this may be an optimal solution for providing stable outcomes after emergency surgery for acute type A aortic dissection. However, we experienced two complications of arm ischemia, attention should be paid to potential arm ischemia.

Systematic Innominate Artery Cannulation Strategy in Acute Type A Aortic Dissection: Better Perfusion, Better Results

“…This often leads to high pressures on the arterial outflow line of the CPB circuit and the inability to deliver the required flow rate which can result in under-perfused territories or aggravate pre-existing malperfusion. Certain authors supplement axillary cannulation with femoral cannulation or even contralateral axillary cannulation, in order to overcome this problem [27,28]. Direct aortic cannulation offers the same advantages with regard to perfusion but it is much more hazardous, as the risk of selectively perfusing the false lumen is much higher [9], while it is not applicable to patients in cardiogenic shock, or to those with a circumferential entry site [29,30].…”