Direct Axillary Artery Cannulation for Aortic Surgery: Lessons From Contemporary Experiences

Authors

Suguru Ohira, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York. Electronic address: Suguru.Ohira@wmchealth.org.
Masashi Kai, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
Joshua B. Goldberg, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
Ramin Malekan, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
Steven L. Lansman, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
David Spielvogel, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.

Author Type(s)

Faculty

Journal Title

The Annals of Thoracic Surgery

First Page

1341

Last Page

1347

Document Type

Article

Publication Date

10-1-2022

Department

Surgery

Abstract

BACKGROUND: This study seeks to assess the outcomes of direct axillary artery (AX) cannulation for thoracic aortic surgery. METHODS: From October 2009 to November 2021 direct AX cannulation was planned in 515 patients for thoracic aortic pathology. An important aspect of our technique is that the cannula is not inserted deeper than 3 cm. AX cannulation-related events included shift of cannulation site from the initial site, vascular injury, and iatrogenic dissection. RESULTS: Half of the patients had acute type A dissection (ATAD). An angled cannula was used in 442 patients and a straight cannula in 73 patients (14.2%) after August 2020. A previously cannulated AX was reused in 36 patients (7.0%). Mortality and stroke rates were 5.4% (ATAD vs non-ATAD: 8.0% vs 2.8%, P = .008) and 2.7% (ATAD vs non-ATAD: 4.6% vs 0.8%, P = .034), respectively. AX cannulation-related events were observed in 2.7% of patients. There was no difference in the vascular injury rate between ATAD and non-ATAD cases (1.6% vs 0.4%, respectively; P = .385), between different cannula types (angled vs straight: 0.9% vs 1.4%, P = 1.00), or between primary and redo AX cannulation cases (0.8% vs 2.8%, respectively; P = .791). On multidetector computed tomography analysis using automated 3-dimensional images, the mean distance from the thoracoacromial artery to the vertebral artery on the right and left sides was 8.70 cm and 8.69 cm, respectively. CONCLUSIONS: Direct AX cannulation for thoracic aortic repair is safe and carries a low rate of vascular injury, especially in elective cases. Our direct cannulation technique, which includes not inserting a cannula deeper than 3 cm, seems to be safe in not occluding the vertebral artery.

Recommended Citation

Ohira, S., Kai, M., Goldberg, J. B., Malekan, R., Lansman, S. L., & Spielvogel, D. (2022). Direct Axillary Artery Cannulation for Aortic Surgery: Lessons From Contemporary Experiences. The Annals of Thoracic Surgery, 114 (4), 1341-1347. https://doi.org/10.1016/j.athoracsur.2022.02.048