ARTERIAL INFLOW VIA AN AXILLARY ARTERY GRAFT FOR THE SEVERELY ATHEROMATOUS AORTA

Background. Strategy for severe aortic atheromatous disease identified by intraoperative epiaortic ultrasound remains to be determined. We u sed axillary artery inflow through graft interposition in an attempt t o avoid potential embolization. Methods. Between July 1995 and June 19 97, axillary artery inflow was used in 29 patients. Procedures perform ed were coronary artery bypass in 21 patients (3 with combined carotid endarterectomy), aortic valve replacement in 2, valve replacement plu s coronary artery bypass in 4, atrial septal defect repair in 1, and a rch replacement in 1 patient. Fibrillatory arrest was used in 16 patie nts and circulatory arrest was used in 16 patients for excision of mob ile atheroma or arch reconstruction. Antegrade cerebral perfusion thro ugh the axillary artery graft was carried out in 11 patients. Results. There were no brachial neurovascular complications. Two operative dea ths occurred. Two patients had operative strokes and 2 more had postop erative stroke, all with resolution at late follow-up. There were no s trokes in the subset of patients who had antegrade cerebral perfusion during circulatory arrest. Conclusions. The axillary artery is an exce llent site for arterial inflow. Furthermore, antegrade cerebral perfus ion is easily accomplished during periods of circulatory arrest. Final ly, graft placement avoids potential local neurovascular complications . (Ann Thorac Surg 1998;66:33-7) (C) 1998 by The Society of Thoracic S urgeons.