An Alternate Approach: Percutaneous Axillary Cannulation For Minimally Invasive Cardiac Surgery
Jenna L. Mandel, Jake L. Rosen, Colin C. Yost, Kyle W. Prochno, T. Sloane Guy.
Thomas Jefferson University, Philadelphia, PA, USA.
BACKGROUND: The femoral artery and vein are conventionally used to establish peripheral cardiopulmonary bypass (CPB) during robotic cardiac procedures. An alternate approach to arterial cannulation via the axillary artery should be considered in patients with extensive peripheral atherosclerotic disease or calcification of the descending aorta. We aim to highlight our experience using axillary artery cannulation to safely facilitate CPB for minimally invasive cardiac surgery (MICS).
METHODS: Four patients who underwent robotic cardiac surgery utilizing the axillary artery for percutaneous cannulation between November 2019 and August 2021 at a single center were identified. Preoperative, intraoperative, and postoperative data were collected and analyzed to support this case series.
RESULTS: Four patients were included in the analysis, all of whom were male. The mean age was 68 years [range 61-72 years], and mean preoperative ejection fraction was 63%. Preoperative characteristics for each patient are described in Table 1. Axillary artery cannulation was planned preoperatively in three (75%) of the procedures and was employed during one (25%) case due to unsafe femoral perfusion. Mean CPB time (n=3) was 148 minutes [135-157 min] and mean cross clamp time (n=2) was 97 minutes. There were no perioperative hematomas, brachial plexus injuries, or neurovascular injuries. Postoperative 30-day follow-up was similarly uneventful; there was no postoperative mortality, vessel injury, stroke, new-onset atrial fibrillation, or life-threatening bleeding. All four patients maintained full postoperative functionality of the arm ipsilateral to percutaneous axillary cannulation.
CONCLUSIONS: Percutaneous cannulation of the axillary artery is a novel and promising CPB modality for robotic valve repair in patients with extensive peripheral and aortic atherosclerotic disease. Although it has historically been avoided due to concerns regarding lumen size, compressibility, and nerve injury, we have not found these to be substantiated in our experience.
LEGEND: CAD, Coronary Artery Disease; CPB, Cardiopulmonary Bypass; MVP, mitral valve repair; CABG, coronary artery bypass surgery; ASD, atrial septal defect; Sheath size, indicates sheath used for axillary artery cannulation; Functional deficit, refers to inability to use arm ipsilateral to axillary cannulation.
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