70 : Outcome of Aortic Arch Surgery in Patients Aged 70 Years or Older: Axillary Artery Cannulation and Selective Cerebral Perfusion Supports Yasuhisa Takao Tetsuro Fumihiro Kunihiro Masataka Kazue Kiyoshige SHIMAZAKI, MD WATANABE, MD UCHIDA, MD TAKEDA, MD UESHO, MD KOSHIKA, MD NAKASHIMA, MD INUI, MD Abstract Objectives. Axillary artery cannulation, selective cerebral perfusion and replacement of the ascending and arch aorta with an elephant trunk were evaluated to reduce cerebral complications in aortic arch surgery in patients with aortic aneurysm or aortic dissection involving the aortic arch. Methods and Results. A total of 45 patients 8 with acute A type aortic dissection and 7 with chronic aortic aneurysm involving the aortic arch aged 70 9 mean age 74 years underwent total aortic arch replacement from March 996 to May 00. There were three operative deaths in patients with acute A type aortic dissection caused by massive cerebral infarction, bleeding and myocardial infarction, and one hospital death of sepsis. Overall in-hospital mortality was 8.9% 6.7% in A type dissection and.7% in chronic aneurysm. Operative complications included mediastinitis in four patients 9%, left recurrent laryngeal nerve palsy in eight 8%, and cerebral infarction in four 9%. Three of the patients with cerebral infarction had associated dissection-related cerebral ischemia before surgery. One patient died, and two needed a walking stick. Twelve of 8 patients 67% with acute A type aortic dissection and 6 of 7 96% with chronic aortic aneurysm were discharged on foot. Conclusions. Axillary artery cannulation, selective cerebral perfusion and replacement of the ascending and arch aorta with an elephant trunk provided satisfactory operative results in elderly patients aged 70 years or older, especially in patients with chronic aortic aneurysm involving the aortic arch. J Cardiol 00 Jan ; 4 : 7 Key Words Aneurysms Aortic disease Atherosclerosis Heart surgery Elderly : 990 9585 The Second Department of Surgery, Yamagata University School of Medicine, Yamagata Address for correspondence : SHIMAZAKI Y, MD, The Second Department of Surgery, Yamagata University School of Medicine, Iida-nisi, Yamagata, Yamagata 990 9585 Manuscript received September 8, 00 ; accepted October 4, 00 7
8, 996 00 5 80 70 45 80 9 0% A 8 B 6 70 9 74 Table A 5.5cm A A 4 0 Table 7 9 7 Table 997 7 Table Characteristics of the patients Disease Acute A type aortic dissection Chronic aortic diseases Chronic aortic dissection True aortic aneurysms No. of patients 8 6 Age at operation yr 7 9 70 84 7 8 Total 45 70 9 mean 74 Table Preoperative complications Complications related to acute A type aortic dissection Shock Cardiac tamponade 4 Aortic regurgitation 0 Cerebral infarction Limb ischemia including decreased pressure 5 Myocardial infarction Complications in 7 patients with chronic aortic aneurysms Hypertension 9 Myocardial infarction 7 Cerebral infarction Aortic regurgitation Aortic stenosis Left recurrent laryngeal nerve palsy 5 4 0ml/kg/min 5 :.4 l 8 C 8 C 5ml/kg/min
70 9 5ml/kg/min elephant trunk Elephant trunk4 Hemashield 4.4 l A K 6 C 0 elephant trunk 9% open distal 0 C 5 C 8 C 5 C 4 Table A 6gelatin-resorcinol- Table Concomitant procedures Coronary artery bypass grafting 4 Aortic root replacement Aortic valve replacement Mitral valve replacement Axillo-femoral bypass Table 4 In-hospital deaths Operative deaths Hospital deaths Total 4 8.9% formalin GRF 75 0 04 50 4 C A 6.7% 9 GRF Table 4.% 4 9% 8 9%4 4
0 Table 5 Patients discharged on foot Acute A type aortic dissection 67% Chronic aortic aneurysms 6 96% Total 8 84% 4 9% A 40 A A 9 A 4 4 9 7 8 84% A 8 67% 7 6 96% Table 5 6 % GRF A A 6.7% A 70 International Registry of Acute Aortic Dissection 6 70 7.5% 7 7.7%, 4 A A 8 4
70.7% 9 4,5 8 A GRF GRF A 9 A 6 quality of life A
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