Direct cannulation of the axillary artery for cardiopulmonary bypass is safe and non-inferior to axillary artery cannulation using a side graft
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0105
Submission Type:
Abstract Submission
Authors:
Dane Paneitz (1), Duc Giao (2), Fernando Ramirez Del Val (3), George Tolis Jr (4), Motahar Hosseini (3), Jordan Bloom (3), Asishana Osho (3), Nathaniel Langer (3), Eriberto Michel (3), Serguei Melnitchouk (3), David D'Alessandro (3), Thoralf Sundt (3), Arminder Jassar (3)
Institutions:
(1) Johns Hopkins Hospital, Baltimore, MD, (2) Harvard Medical School, Boston, MA, (3) Massachusetts General Hospital, Boston, MA, (4) Brigham and Women's Hospital, Boston, MA
Submitting Author:
Dane Paneitz
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Johns Hopkins Hospital
Johns Hopkins Hospital
Co-Author(s):
Duc Giao
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Harvard Medical School
Harvard Medical School
Fernando Ramirez Del Val
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Massachusetts General Hospital
Massachusetts General Hospital
George Tolis
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Brigham and Women's Hospital
Brigham and Women's Hospital
Motahar Hosseini
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Massachusetts General Hospital
Massachusetts General Hospital
Jordan Bloom
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Massachusetts General Hospital
Massachusetts General Hospital
Asishana Osho
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Massachusetts General Hospital
Massachusetts General Hospital
Nathaniel Langer
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Massachusetts General Hospital
Massachusetts General Hospital
Eriberto Michel
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Massachusetts General Hospital
Massachusetts General Hospital
*Serguei Melnitchouk
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Massachusetts General Hospital
Massachusetts General Hospital
*David D'Alessandro
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Massachusetts General Hospital
Massachusetts General Hospital
*Thoralf Sundt
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Massachusetts General Hospital
Massachusetts General Hospital
*Arminder Jassar
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Massachusetts General Hospital
Massachusetts General Hospital
Presenting Author:
*Arminder Jassar
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Massachusetts General Hospital
Massachusetts General Hospital
Abstract:
Objectives
The right axillary artery is a common alternative arterial cannulation site for certain cases requiring cardiopulmonary bypass. Previous studies have found direct axillary artery cannulation (AAC) associated with an increased risk of stroke and cannulation-related complications compared to cannulation with a side graft. We sought to analyze our institutional experience and hypothesized that there would be no difference in stroke rates by the AAC method.
Methods
We identified all patients who underwent AAC between January 2011 and June 2022 using our institutional Society of Thoracic Surgeons adult cardiac surgery database. The cannulation technique was based on the surgeons' discretion. A chart review was performed to confirm the AAC method, measure the axillary artery diameter, and to obtain additional outcomes of axillary artery cannulation-related complications. Patients were divided into two cohorts based on the cannulation technique: direct cannulation (n=131) vs. cannulation using a side graft (n=333). The primary outcome was stroke, and secondary outcomes included operative mortality, axillary artery cannulation related complications, blood product use, reoperation, and new dialysis requirement. Baseline demographics, operative characteristics, and outcomes were compared using Wilcoxon rank sum test or Fisher's exact test as appropriate.
Results
There was no difference in sex, age, race, BMI, diabetes, preoperative creatinine, lung disease, peripheral vascular disease, immunocompromised, cerebrovascular disease, cardiogenic shock, heart failure, connective tissue disorder, aortic pathology (acute dissection, aneurysm, degenerative aneurysm), urgent/emergent status, reoperation, cardiopulmonary bypass or cross clamp time between the groups. Direct axillary artery cannulation cohort had a higher proportion of hypertension (88.5% vs 79.0%, p=0.02), a slightly larger median axillary artery diameter (8.1 mm vs 7.8 mm, p<0.01), a higher proportion of patients with previous aortic operation (26.0% vs 17.1%, p=0.04), and underwent more partial arch replacements (19.8% vs 8.7%, p<0.01) and cases requiring circulatory arrest (83.2% vs 71.2%, p=0.01). The side graft cohort had a longer median procedure time (428.2 minutes vs 404.1, p=0.04). Outcomes are presented in Table 1. There was no difference in the primary outcome of stroke between the groups (9.9% direct vs 8.4% side graft, p=0.59). In addition, there was no difference in the secondary outcomes of operative mortality, axillary cannulation related complications, blood products used, reoperation, or new dialysis requirements.
Conclusions
Overall complications from axillary artery cannulation were low. There was no difference in stroke rate or cannulation-related complications between direct versus side graft AAC in our institutional cohort. Direct axillary artery cannulation had a shorter median procedure time. These findings suggest that direct axillary artery cannulation is a safe technique for arterial cannulation.
The right axillary artery is a common alternative arterial cannulation site for certain cases requiring cardiopulmonary bypass. Previous studies have found direct axillary artery cannulation (AAC) associated with an increased risk of stroke and cannulation-related complications compared to cannulation with a side graft. We sought to analyze our institutional experience and hypothesized that there would be no difference in stroke rates by the AAC method.
Methods
We identified all patients who underwent AAC between January 2011 and June 2022 using our institutional Society of Thoracic Surgeons adult cardiac surgery database. The cannulation technique was based on the surgeons' discretion. A chart review was performed to confirm the AAC method, measure the axillary artery diameter, and to obtain additional outcomes of axillary artery cannulation-related complications. Patients were divided into two cohorts based on the cannulation technique: direct cannulation (n=131) vs. cannulation using a side graft (n=333). The primary outcome was stroke, and secondary outcomes included operative mortality, axillary artery cannulation related complications, blood product use, reoperation, and new dialysis requirement. Baseline demographics, operative characteristics, and outcomes were compared using Wilcoxon rank sum test or Fisher's exact test as appropriate.
Results
There was no difference in sex, age, race, BMI, diabetes, preoperative creatinine, lung disease, peripheral vascular disease, immunocompromised, cerebrovascular disease, cardiogenic shock, heart failure, connective tissue disorder, aortic pathology (acute dissection, aneurysm, degenerative aneurysm), urgent/emergent status, reoperation, cardiopulmonary bypass or cross clamp time between the groups. Direct axillary artery cannulation cohort had a higher proportion of hypertension (88.5% vs 79.0%, p=0.02), a slightly larger median axillary artery diameter (8.1 mm vs 7.8 mm, p<0.01), a higher proportion of patients with previous aortic operation (26.0% vs 17.1%, p=0.04), and underwent more partial arch replacements (19.8% vs 8.7%, p<0.01) and cases requiring circulatory arrest (83.2% vs 71.2%, p=0.01). The side graft cohort had a longer median procedure time (428.2 minutes vs 404.1, p=0.04). Outcomes are presented in Table 1. There was no difference in the primary outcome of stroke between the groups (9.9% direct vs 8.4% side graft, p=0.59). In addition, there was no difference in the secondary outcomes of operative mortality, axillary cannulation related complications, blood products used, reoperation, or new dialysis requirements.
Conclusions
Overall complications from axillary artery cannulation were low. There was no difference in stroke rate or cannulation-related complications between direct versus side graft AAC in our institutional cohort. Direct axillary artery cannulation had a shorter median procedure time. These findings suggest that direct axillary artery cannulation is a safe technique for arterial cannulation.
Aortic Symposium:
Other - Cannulation and Perfusion Strategies
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