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Axillary artery cannulation for aortic and complex cardiac surgery
1Department of Cardiothoracic Surgery, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia. levi.bassin@gmail.com
Insights
Axillary artery cannulation for cardiopulmonary bypass is a safe technique, reducing risks of atheroemboli and malperfusion. This method offers a reliable alternative for complex aortic and cardiac surgeries, minimizing complications.
Area of Science:
- Cardiovascular Surgery
- Vascular Access
- Surgical Techniques
Background:
- Ascending aorta manipulation is avoided with axillary artery cannulation for cardiopulmonary bypass (CPB).
- This technique offers reduced risks of atheroemboli and malperfusion in aortic dissections.
- Facilitates selective antegrade cerebral perfusion (SACP) during hypothermic circulatory arrest (HCA).
Purpose of the Study:
- To evaluate the safety and efficacy of axillary artery cannulation.
- To assess outcomes in patients undergoing aortic and cardiac surgery where the ascending aorta was unapproachable.
Main Methods:
- A single surgeon's 7-year experience with axillary cannulation (side-graft technique) in 116 patients.
- Indications included acute Type A dissection (22), elective aortic surgery (70), CPB before redo sternotomy (5), and porcelain aorta (19).
- Hypothermic circulatory arrest (HCA) was used in 98 cases, with SACP in 18.
Main Results:
- Three postoperative deaths occurred (multi-system failure, stroke, unknown cause).
- 113 patients were discharged well, with no major complications attributed to axillary artery use.
- Low morbidity and mortality rates were observed.
Conclusions:
- Axillary artery cannulation is a safe and reliable technique for arterial inflow.
- It minimizes risks of atheroembolisation and malperfusion.
- Recommended as a standard approach for complex aortic and cardiac surgery.
Background:
Cannulation of the axillary artery for cardiopulmonary bypass (CPB) avoids manipulation of an atherosclerotic, aneurysmal, or dissected ascending aorta. Advantages include: low risk of atheroemboli, low risk of malperfusion in dissections, and facilitates selective antegrade cerebral perfusion (SACP) during hypothermic circulatory arrest (HCA).
Methods:
A single surgeon's seven year experience of axillary cannulation using the side-graft technique in 116 consecutive patients (age 22-87 years) in aortic and cardiac surgery where the ascending aorta was unapproachable. The indication for axillary cannulation was: (i) acute Type A dissection in 22, (ii) elective aortic surgery in 70, (iii) CPB prior to redo sternotomy in five, and (iv) a porcelain aorta in 19. HCA was used in 98 cases and additionally SACP was used in 18 cases.
Results:
There were three postoperative deaths, one from multi-system failure, one stroke, and one post discharge from an unknown cause. All 113 other patients were well and discharged home. There were no major complications related to axillary artery use.
Conclusion:
Axillary artery cannulation is a safe and reliable technique for arterial inflow minimising the risks of atheroembolisation and malperfusion reflected by low morbidity and mortality, and should be the standard in aortic and complex cardiac surgery.
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