Ann Thorac Surg 2010;90:737. doi:10.1016/j.athoracsur.2010.04.082
© 2010 The Society of Thoracic Surgeons
Original Articles: Adult Cardiac
Invited Commentary
Eugenio Neri, MD
Unità Operativa di Chirurgia dell'Aorta Toracica, Policlinico "Santa Maria alle Scotte", Viale M. Bracci, Siena, 53100 Italy
(Email: euxneri{at}tin.it).
In 1999, we published the very first series dedicated to axillary artery cannulation in acute type A aortic dissection [1]. We knew very little from previous experiences [2]. We mainly sought a reliable antegrade route of perfusion, possibly not involved in dissection, which was useful to deal with the maze of aortic false channels and re-entries. At that time the potential of this route of perfusion had yet to be fully exploited; selective cerebral perfusion was not yet widespread, the use of brachiocephalic selective cerebral perfusion had yet to become popular, and moderately hypothermic circulatory arrest was unfamiliar. In the following years we all learned a lot, and now we are able to treat these patients more safely and with less complications. We strongly believe that axillary artery perfusion represents a cornerstone and a real breakthrough of modern aortic surgery.
The study by Wong and coworkers [3] addresses the results of axillary artery cannulation beyond the immediate postoperative period in a very large cohort of patients with type A aortic dissection.
Although Wong and colleagues [3] study was merely based on phone interviews, it is an important article, because (as many follow-up studies do) it certifies the maturity of this technique. Their study clearly demonstrates the safety of the technique and the low rate of associated complications in the medium term.
Nonetheless, some crucial questions regarding axillary artery perfusion are still open. Does this route of perfusion reduce the prevalence of false channel patency after surgery? Does it positively influence the topology of the dissected aorta by preventing perioperative malperfusion and promoting the closure of the false channel? Is the outcome of patients who receive axillary artery perfusion better than the outcomes of those from other approaches? It is likely that on the basis of their large (and excellent) experience, using the extraordinary volume of data available in the world's most renowned center for aortic surgery, these same researchers can easily answer these questions in the near future.
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References
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- Neri E, Massetti M, Capannini G, et al. Axillary artery cannulation in type A aortic dissection operations J Thorac Cardiovasc Surg 1999;118:324-329.[Abstract/Free Full Text]
- Sabik JF, Lytle BW, McCarthy PM, Cosgrove DM. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease J Thorac Cardiovasc Surg 1995;109:885-890.[Abstract]
- Wong DR, Coselli JS, Palmero L, et al. Axillary artery cannulation in surgery for acute or subacute ascending aortic dissections Ann Thorac Surg 2010;90:731-737.[Abstract/Free Full Text]
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Axillary Artery Cannulation in Surgery for Acute or Subacute Ascending Aortic Dissections
- Daniel R. Wong, Joseph S. Coselli, Laura Palmero, John Bozinovski, Stacey A. Carter, Daniel Murariu, and Scott A. LeMaire
Ann. Thorac. Surg. 2010 90: 731-737.
[Abstract]
[Full Text]
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