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Original Articles: Adult Cardiac

Axillary Cannulation Significantly Improves Survival and Neurologic Outcome After Atherosclerotic Aneurysm Repair of the Aortic Root and Ascending Aorta

Mount Sinai School of Medicine, New York, New York

Accepted for publication February 27, 2008.

^_* Address correspondence to Dr Etz, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Pl, New York, NY 10029 (Email: christian.etz{at}mountsinai.org).

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.

Background: The impact of axillary artery cannulation (AXC) on survival and neurologic outcome after operation for ascending aortic disease was retrospectively evaluated.

Methods: We reviewed 869 patients with ascending aorta/root repairs (1995 to 2005), principally for atherosclerotic and degenerative aneurysms and chronic and acute type A dissections. Arterial cannulation was through the ascending aorta (AAC) in 157 patients, the femoral artery (FAC) in 261, and the right axillary artery (AXC) in 451. Patients cannulated at different sites were compared for preoperative comorbidities and outcomes (mortality and stroke) for each cause.

Results: Of the 122 patients with atherosclerotic aneurysms, 66 with right AXC had significantly better outcomes (p = 0.02): 64 of 66 survived vs 24 of 26 with FAC and 27 with 30 of AAC; no strokes occurred (vs 2 of 26 with FAC and 4 of 30 with AAC). No significant advantage for AXC was found with ascending aortic operation in 495 degenerative aneurysms, 106 chronic, or 65 acute type A dissections, 41 patients with endocarditis, or in 18 with aneurysms of other causes; AXC was associated with a significantly better outcome (p = 0.05) in the 869 patients taken together.

Conclusions: AXC resulted in superior survival and neurologic outcome in patients with atherosclerotic aneurysms and a marginally better outcome than with cannulation at other sites during proximal aortic procedures for all causes. This study supports AXC in patients with atherosclerotic disease who require complex cardiothoracic operations and in patients requiring proximal aortic intervention regardless of cause.

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