ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Direct cannulation of axillary artery via transpectoral approach in ascending aorta and aortic arch surgery
Gökhan Özerdem1, Özcan Özdemir2, Bülent Kaya3
1Departments of Cardiovascular Surgery, Çağ Hospital, Ankara
2Departments of Cardiology, Çağ Hospital, Ankara
3Department of Cardiovascular Surgery, Medicine Faculty of Ankara University, Ankara
DOI : 10.5606/tgkdc.dergisi.2011.077
Background: Right axillary artery cannulation provides some advantages in case of circulatory arrest during cardiopulmonary bypass (CPB), including antegrade whole body perfusion flow and unilateral antegrade cerebral perfusion, without requiring any additional cannulation of brachiocephalic arteries and eliminates the need to recannulate the graft before reestablishing CPB in aortic dissection cases.

Methods: We performed right axillary artery cannulation in 82 patients (38 males, 44 females; mean age 59.5±10.6 years; range 32 to 85 years) with the ascending aorta or aortic arch pathologies. Preoperative diagnosis was classified as aneurysm of the ascending aorta or aortic arch due to arteriosclerosis or degeneration (n=46, 56.1%), acute type A aortic dissection (n=28, 34.1%), and porcelain aorta (n=6, 7.3%). All of the patients underwent replacement of the ascending aorta and in 21 of these patients, replacement of the ascending aorta was extended to the hemiarch. Five of the patients underwent total aortic arch replacement. A modified Bentall procedure was performed on 52 patients, and supracoronary graft implantation was performed on 30 patients.

Results: According to clinical examination no complications related to axillary artery cannulation, such as brachial plexus injury, axillary artery thrombosis, or local wound infection, were observed. The mean CPB time and aortic cross-clamp time were 190.8±62.0 min and 72.0±21.7 min, respectively.

Conclusion: Postoperatively, five patients died and one patient developed a new stroke. We think that the full-flow CPB performed using axillary cannulation via transpectoral approach with subclavicular incision is a feasible and safe method with acceptable morbidity and mortality.

Keywords : Aortic arch; ascending aorta; right axillary artery cannulation
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