Modification of port-access coronary artery bypass in high-risk patients

Minimally invasive port-access coronary artery bypass surgery has many potential advantages over routine median sternotomy coronary revascularization in patients with serious co-morbid conditions. The common femoral artery and vein have been the standard peripheral cannulation and balloon deployment sites. However, these sites present some risk, especially from proximal arteriosclerotic or aneurysmal disease.

We utilized Heartport endovenous and endoaortic cannulas (Heartport Inc, Redwood City, CA) for axilloaxillary or femoral-descending aortic cardiopulmonary bypass in 9 patients in an attempt to avoid potential cerebral and systemic embolization. All patients were successfully cannulated and the endoaortic clamp was deployed to perform a total of eleven grafts (five right coronary arteries and six circumflex coronary arteries). The patients ranged from 66 to 80 years of age. Five patients had abdominal aortic aneurysmal disease and 4 had severe peripheral vascular disease.

All patients achieved full cardiopulmonary bypass with flows in excess of 3 L/min. without difficulty. There were no complications referable to the arm and its neurovascular structures. All axillary arteriotomies were closed primarily, without the need for thrombectomy or reconstruction. There were no neurological complications and 30-day survival was 100%. Three patients underwent successful abdominal aortic aneurysm resection prior to discharge.

Axilloaxillary and femoral-descending aortic cannulation utilizing standard Heartport cannulas (Heartport, Inc) offer alternative sites for cardiopulmonary bypass in patients with severe peripheral vascular disease.