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Ann Thorac Surg 2004;78:103-108
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Axillary artery cannulation: routine use in ascending aorta and aortic arch replacement

Justus T. Strauch, MDa*, David Spielvogel, MDa, Alexander Lauten, MSa, Steven L. Lansman, MD, PhDa, Kirk McMurtry, MDa, Carol A. Bodian, DrPhMa, Randall B. Griepp, MDa

a Departments of Cardiothoracic Surgery and Biomathemathics, The Mount Sinai Medical Center, New York University, New York, New York, USA

Accepted for publication January 22, 2004.

* Address reprint requests to Dr Strauch, Mount Sinai School of Medicine, Department of Cardiothoracic Surgery, One Gustave L. Levy Place, PO Box 1028, New York, NY 10029, USA
e-mail: ju.strauch{at}gmx.de

Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.

BACKGROUND: Ideal perfusion during ascending aorta-arch surgery should allow easy implementation of antegrade cerebral perfusion while avoiding atheroembolization or false lumen perfusion in dissections. We report favorable experience with direct axillary artery cannulation.

METHODS: Between 1999 and 2003, 284 patients with a mean age of 62.2 years (25 to 85), underwent axillary artery cannulation using a right angle wire-reinforced catheter. During this interval, attempted axillary cannulation was abandoned in only 14 patients because of inadequate backflow or other complications. Eighty-five patients were female. Severe aortic arteriosclerosis or degeneration was present in 209, aortic dissection in 63, and Marfan disease or aortitis in 12. The Bentall procedure was done in 144 patients, arch replacement in 86, the Yacoub procedure in 18, thoracoabdominal aneurysm repair in 16, and coronary artery bypass grafting in 20. Reoperations were at 30.2%.

RESULTS: Adverse outcome (hospital death or permanent stroke) occurred in 6.6% (n = 19). Thirteen patients (4.6%) died before hospital discharge, and 13 patients (4.6%; 9 of whom died) suffered permanent stroke. Transient neurologic dysfunction occurred in 9.2% (n = 26). Mean duration of hypothermic circulatory arrest, used in 246 patients, was 26 ±7 minutes. Mean duration of antegrade cerebral perfusion, used in 139 patients, was 47 ± 23 minutes. In 93%, the right axillary artery was cannulated. Complications included 2 cases (0.7%) of brachial plexus injury (one transient), and 3 (1%) of localized dissection.

CONCLUSIONS: Our results suggest that axillary artery cannulation, successful in 95% of patients, may be the optimal technique for reducing perfusion-related morbidity and adverse outcome in operations for acute dissection, atherosclerotic, and degenerative aneurysmal disease. It deserves serious consideration in all patients older than 65 requiring cardiopulmonary bypass.




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