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J Thorac Cardiovasc Surg 2001;122:188-189
© 2001 The American Association for Thoracic Surgery

Brief Communications

Staged perfusion with an axillary artery graft and deep hypothermia during descending aortic replacement

Toshiki Takahashi, MD, Yasuhisa Shimazaki, MD, Takao Watanabe, MD, Takashi Minowa, MD, Masataka Koshika, MD, Kiyoshige Inui, MD, Jun Hosaka, MD, Shuji Toyama, MD, Yamagata, Japan

From the Second Department of Surgery, Yamagata University School of Medicine, Yamagata, Japan.

Received for publication Aug 16, 2000. Accepted for publication Nov 30, 2000. Address for reprints: Toshiki Takahashi, MD, Second Department of Surgery, Yamagata University School of Medicine, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan (E-mail: toshiki@surg1.med.osaka-u.ac.jp).

Prevention of neurologic injury is one of the most important goals in reconstruction of the distal aortic arch. Femoral perfusion has a potential of embolic ischemic events including stroke and visceral malperfusionGo Go 1,2 in patients with chronic type B dissection. We have introduced an antegrade systemic perfusion technique via the left axillary artery graft for replacement of the descending thoracic aorta in 2 recent patients with chronic type B aortic dissection. This technique allows us to reconstruct the distal descending aorta, including the lower intercostal arteries, first during upper body cooling. We then can create an open proximal anastomosis with deep hypothermic retrograde cerebral perfusion with subsequent antegrade perfusion to the lower part of the body through the side branch of the distal aortic graft.

Operative technique

The patient was intubated with a double-lumen tube and then placed in a left thoracotomy position, the hips swiveled for the femoral cannulation and the left upper arm hung for the axillary cannulation. After systemic heparinization, an 8-mm woven Dacron graft (Meadox Medicals, Inc, Oakland, NJ) was anastomosed to the left axillary artery and connected to an arterial cannula for an arterial line. Cardiopulmonary bypass was established with two venous cannulas via the right femoral . . . [Full Text of this Article]






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