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Axillary artery cannulation reduces early embolic stroke and mortality after open arch repair with circulatory arrest

Authors
 Jung-Hwan Kim  ;  Seung Hyun Lee  ;  Sak Lee  ;  Young-Nam Youn  ;  Kyung-Jong Yoo  ;  Hyun-Chel Joo 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.159(3) : 772-778.e4, 2020 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2020
MeSH
Aged ; Aorta, Thoracic/physiopathology ; Aorta, Thoracic/surgery* ; Aortic Diseases/physiopathology ; Aortic Diseases/surgery* ; Axillary Artery*/physiopathology ; Catheterization, Peripheral*/adverse effects ; Catheterization, Peripheral*/mortality ; Cerebrovascular Circulation* ; Female ; Heart Arrest, Induced*/adverse effects ; Heart Arrest, Induced*/mortality ; Hospital Mortality ; Humans ; Intracranial Embolism/etiology ; Intracranial Embolism/mortality ; Intracranial Embolism/physiopathology ; Intracranial Embolism/prevention & control* ; Male ; Middle Aged ; Perfusion*/adverse effects ; Perfusion*/mortality ; Punctures ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke/etiology ; Stroke/mortality ; Stroke/physiopathology ; Stroke/prevention & control* ; Time Factors ; Treatment Outcome ; Vascular Surgical Procedures*/adverse effects ; Vascular Surgical Procedures*/mortality
Keywords
axillary artery ; open arch repair ; stroke
Abstract
OBJECTIVE: To evaluate the efficacy of axillary artery cannulation for early embolic stroke and operative mortality, we retrospectively compared the outcomes between patients with or without axillary artery cannulation during open aortic arch repair with circulatory arrest. METHODS: Between January 2004 and December 2017, 468 patients underwent open aortic arch repair with circulatory arrest using antegrade cerebral perfusion and were divided into 2 groups according to the site of arterial cannulation: the axillary artery (axillary group, n = 352) or another site (nonaxillary group, n = 116) groups. Embolic stroke was defined as a physician-diagnosed new postoperative neurologic deficit lasting more than 72 hours, generally confirmed by computed tomography or magnetic resonance imaging. RESULTS: After propensity score matching, the patients' characteristics were comparable between the groups (n = 116 in each). The incidences of acute type A dissection, aortic rupture, shock, or emergency operation were similar between groups. The incidence of early embolic stroke was significantly lower in axillary group (n = 3 [2.6%] vs n = 10 [8.6%]; P = .046). Also, 30-day mortality (n = 3 [2.6%] vs n = 10 [8.6%]; P = .046) and in-hospital mortality (n = 3 [2.6%] vs n = 11 [9.5%]; P = .027) occurred significantly lower in the axillary group. CONCLUSIONS: Axillary artery cannulation reduced the early embolic stroke and early mortality after open arch repair with circulatory arrest. Axillary artery cannulation as the arterial cannulation site during open arch repair with circulatory arrest may be helpful in preventing embolic stroke and reducing early mortality.
Files in This Item:
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DOI
10.1016/j.jtcvs.2019.02.112
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jung Hwan(김정환)
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175680
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