Methods: All surgeries were performed through a median sternotomy. Direct cannulation of the right axillary artery at the armpit was used for cardiopulmonary bypass and antegrade selective cerebral perfusion under deep (20°C) to moderate (28°C) hypothermia. Into the right axillary artery, 12 - 16 Fr thin wall cannulae were used. In addition, ascending aortic and/or femoral perfusion was also used for total cardiopulmonary bypass. In total, consecutive 531 patients (70.1±10.8 year old) requiring various arch surgeries between Oct. 1999 and Oct. 2006 were involved in this retrospective study. Of them, 120 patients (22.6%) underwent emergency surgery for acute type A dissection or rupture of non-dissecting aneurysm. There were 146 (27.5%) dissecting and 385 non-dissecting aortic lesions. The surgeries included total arch replacement in 437 patients, partial arch replacement in 10 patients, and hemiarch replacement in 85 patients.

Results: The whole mortality rate was 4.0% (n= 21/531). There was no significant difference in the mortality rate between emergency and elective surgery; 6.7% (8/120) in the emergency settings and 3.2% (13/411) in the elective surgery (p= 0.107). The incidence of permanent neurological deficits was 2.6% (14/531) in all; 2.7% (12/437) in total arch replacement and 2.1% (2/95) in hemiarch or partial arch replacement. Two of them developing permanent dysfunction expired. The incidence of temporary deficits was 5.5% (29/531) in all; 4.0% (4/95) in hemiarch or partial arch replacement and 5.7% (25/437) in total arch replacement. Statistically, there were no significant risk factors for mortality and cerebral morbidities.

Conclusion: The right axillary artery perfusion is an advantageous adjunct for cardiopulmonary bypass and antegrade selective cerebral perfusion for secure arch surgery. With the integrated antegrade selective cerebral perfusion through right axillary artery perfusion, moderate hypothermic arch surgery would be allowed.