{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:46:21Z","timestamp":1793133981069,"version":"4.5.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T00:00:00Z","timestamp":1610668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2002<\/jats:title>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>In patients with atherosclerotic disease, minimally invasive cardiac surgery using retrograde perfusion for cardiopulmonary bypass via femoral cannulation (FC) carries a higher risk of brain embolization compared with antegrade perfusion. However, guidelines for selecting antegrade versus retrograde perfusion do not exist. We developed a computed tomography (CT)-based perfusion strategy and assessed outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We studied 270 minimally invasive cardiac surgery patients, aged 68\u2009\u00b1\u200913, 124 female, body surface area 1.6\u2009\u00b1\u20090.2\u2009m2. Antegrade perfusion using axillary cannulation (AC) was selected if any of the following preoperative enhanced CT scan criteria were satisfied anywhere in the aorta or iliac arteries: thrombosis thickness &amp;gt;3\u2009mm, thrombosis &amp;gt;one-third of the total circumference and calcification present in the total circumference. FC was selected otherwise. Asymptomatic brain injury was assessed by diffusion-weighted magnetic resonance imaging.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>AC and FC were selected in 95 (35%) and 175 patients, respectively. AC patients were 10\u2009years older (P\u2009&amp;lt;\u20090.001) and had higher EuroSCORE II (2.7\u2009\u00b1\u20093.4 vs 1.7\u2009\u00b1\u20091.9, P\u2009=\u20090.002). The median cardiopulmonary time and cross-clamp times were not significantly different. No patients died in hospital. There was no immediate stroke in either group during 48\u2009h after surgery. Asymptomatic brain injury was detected in 25 (26%) and 27 (15%) AC and FC patients, respectively, P\u2009=\u20090.03.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>We believe our CT-based perfusion strategy using AC or FC minimized brain embolic rates. AC can be a good alternative to prevent brain embolization for minimally invasive cardiac surgery patients with advanced atherosclerotic disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa469","type":"journal-article","created":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T20:59:39Z","timestamp":1607461179000},"page":"1200-1207","source":"Crossref","is-referenced-by-count":23,"title":["Perfusion strategy using axillary or femoral cannulation for minimally invasive cardiac surgery: experience in 270 patients with computed tomography-based criteria"],"prefix":"10.1093","volume":"59","author":[{"given":"Yoshitsugu","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Chibanishi General Hospital, Matsudo-city, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Nishijima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Chibanishi 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