Axillary artery cannulation provides balanced cerebral oxygenation

Area of Science:

• Cardiovascular Surgery
• Neurology
• Medical Devices

Background:

• Cerebral performance decline is a significant issue post-cardiac surgery.
• Axillary artery cannulation may improve outcomes but raises concerns about right hemisphere malperfusion.
• Near-infrared spectroscopic oximetry (NIRO) allows intraoperative monitoring of cerebral oxygenation.

Purpose of the Study:

• To investigate and compare intraoperative cerebral oxygenation between aortic (AoC) and right axillary artery cannulation (AxC) sites.
• To analyze cerebral saturation during critical phases of cardiopulmonary bypass (CPB).
• To evaluate the impact of cannulation site on postoperative neurological outcomes.

Main Methods:

• Retrospective analysis of 20 patients in AoC group and 20 in AxC group undergoing cardiac surgery.
• Bihemispheric NIRO monitoring to measure tissue oxygenation index (TOI).
• Correlation of TOI data with CPB phases (ECC start/stop, cross-clamping, rewarming, declamping) and postoperative neurological assessment.

Main Results:

• No statistically significant cerebral desaturation (>20% for >60s) was observed in either group during CPB or critical phases.
• No significant difference in TOI between left and right hemispheres was found within each group.
• Postoperative outcomes: 2 transient confusional syndromes (CS) in AoC group vs. 3 CS in AxC group.

Conclusions:

• Right axillary artery cannulation maintains balanced cerebral oxygenation during CPB and its critical phases.
• Axillary artery cannulation may mitigate neurological injury risk by ensuring balanced oxygenation and potentially reducing embolization.
• NIRO is effective for monitoring cerebral oxygenation during cardiac surgery with different arterial cannulation strategies.