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J Thorac Cardiovasc Surg 2008;136:648-649
© 2008 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Joseph Coselli (Houston, Tex). Congratulations on an excellent presentation. You report to us an incremental study regarding the Osaka experience with selective cerebral perfusion using axillary artery cannulation. Your approach is unusual in that you cannulate the distal axillary artery using an axillary artery incision and a small cannula, usually 10F to 16F. Because of this, you also cannulate either the ascending aorta or the femoral artery to achieve adequate in-flow. Your results are outstanding, with an operation mortality of 4% and a permanent neurologic deficit of 3% and no significant difference between elective and emergency operations, albeit with less than 8% of patients undergoing reoperation.

As your title suggests, you've evolved your strategy over a number of years with variations in such things as temperature and cannulation techniques. Because your results have been excellent apparently all along, it is not exactly clear to me as to what . . . [Full Text of this Article]