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Hiroo Takayama
Craig R. Smith
Michael E. Bowdish
Allan S. Stewart
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J Thorac Cardiovasc Surg 2009;137:1450-1453
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia

Hiroo Takayama, MD, Craig R. Smith, MD, Michael E. Bowdish, MD, Allan S. Stewart, MD*

Division of Cardiothoracic Surgery, Columbia University, New York, NY

Received for publication July 28, 2008; revisions received October 16, 2008; accepted for publication November 19, 2008.

* Address for reprints: Allan S. Stewart, MD, NewYork-Presbyterian Hospital/Columbia, Milstein Hospital Bldg, Room 7-435, 177 Fort Washington Ave, New York, NY 10032. (Email: as2276{at}columbia.edu).

Objective: Recent advance in surgical technique facilitates more aggressive approaches for thoracic aortic diseases. We sought to address the outcomes of our strategy of open distal anastomosis with aortic root replacement using axillary cannulation and moderate hypothermia.

Methods: A retrospective review of 228 patients who underwent aortic root replacement between July 2004 and December 2007 was performed.

Results: Axillary artery cannulation was successful in 98% of the attempted cases and resulted in no adverse events in 97%. The axillary artery was the site of arterial cannulation in 89% of the cases, among which 136 patients (60% of the cases) underwent an open distal anastomosis, consisting of the cohort of interest. Median age of the patients was 60 years (ranging from 16 to 89 years) with 79% being male. The principal diagnosis for the operation included aneurysmal disease without aortic dissection (78%), type A aortic dissection with or without aneurysm (12%), and endocarditis (5.9%). Performed operations were modified Bentall operation (53% of the cohort), valve-sparing aortic root replacement (26%), and replacement with a homograft (20%). Hemiarch replacement was added in 43%. Mean ± standard deviation of the lowest temperature was 27°C ±2.6°C. There were 5 deaths (mortality 3.7%). A total of 16 patients (12%) had major complications.

Conclusions: Open distal anastomosis at the time of aortic root replacement can safely be performed with axillary artery cannulation and moderate hypothermia. Axillary cannulation provides a reliable route of antegrade cerebral perfusion and enables the complex procedure to be performed without deep hypothermic circulatory arrest.






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