Left Axillary Artery Cannulation Facilitates Reoperative Total Aortic Arch Replacement. Issue 1 (January 2018)

• Record Type: Journal Article
• Authors: Hemli, Jonathan M.; Gu, Bo; Scheinerman, S. Jacob; Brinster, Derek R.
• Is Part Of: Innovations. Volume 13:Issue 1(2018)
• Page Start: 70
• Page End: 73
• Publication Date: 2018-01
• Subjects: Aortic arch replacement -- Reoperation -- Axillary artery -- Debranching; Cardiovascular system -- Surgery -- Periodicals; Heart -- Surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; Thoracic Surgical Procedures -- methods -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Thorax -- Chirurgie -- Méthodologie -- Périodiques; Vaisseaux sanguins -- Chirurgie -- Méthodologie -- Périodiques; Blood-vessels -- Surgery; Chest -- Surgery; Periodicals; 617.41
• DOI: 10.1177/155698451801300115
• Languages: English
• ISSNs: 1556-9845

Abstract

Total aortic arch replacement remains a technically formidable procedure, particularly in patients with previous proximal aortic dissection repair. Our case discussion highlights a useful strategy for extracorporeal support and circulation management to facilitate total arch reconstruction in the reoperative setting, based on cannulation of the left axillary artery. Our preference is to use a left axillary artery approach to initiate cardiopulmonary bypass and to ultimately revascularize the left arm via an extra-anatomic graft. Our technique, as described, affords the option to initiate cardiopulmonary bypass before sternal re-entry, it reduces the risk of embolic complications and possible stroke, and it directly facilitates simple extra-anatomic debranching of the left subclavian artery, resulting in easier arch and great vessel reconstruction within the chest.