Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting
Objective: Cardiopulmonary bypass (CPB) via the right axillary artery (RAA) has become an alternative perfusion strategy, especially in complex aortic procedures. This study delineates our technique and outcome with direct axillary cannulation utilizing the Seldinger technique, which we adopted as t...
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MDPI AG
2025-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/12/1/31 |
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| author | Christian Sellin Ahmed Belmenai Volodymyr Demianenko Marius Grossmann Hilmar Dörge |
| author_facet | Christian Sellin Ahmed Belmenai Volodymyr Demianenko Marius Grossmann Hilmar Dörge |
| author_sort | Christian Sellin |
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| description | Objective: Cardiopulmonary bypass (CPB) via the right axillary artery (RAA) has become an alternative perfusion strategy, especially in complex aortic procedures. This study delineates our technique and outcome with direct axillary cannulation utilizing the Seldinger technique, which we adopted as the standard perfusion strategy in the sternum-sparing minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) using CPB. Methods: From November 2019 to December 2023, a total of 413 consecutive patients underwent nonemergent isolated coronary artery bypass grafting (CABG) via left anterior minithoracotomy on CPB with peripheral cannulation via the RAA and cardioplegic cardiac arrest, using this technique as a default strategy in the daily routine. All patients had multivessel coronary artery disease. The primary outcome was intraoperative cannulation-related complications (bleeding, revision, ischemia, wound healing complications). The secondary outcome was cannulation-related events during follow-up (blood pressure differences, incidence of brachial plexus injury, clinical signs of circulatory problems of arm and hand, re-interventions). Mean midterm follow-up was 18.7 ± 12.3 [1.1–51.2] months. During follow-up, 16 patients died. Overall, a total of 397 patients (344 male; 67.6 ± 9.7 [32–88]) were included for follow-up (100%). Results: The RAA was successfully cannulated in 100% of patients. A cannula size of 16 Fr was used in 34.6%, 18 Fr in 63.9% and 20 Fr in 1.5% of all patients. There was no intraoperative bleeding complication. In two patients, intraoperative revision of the RAA was required, necessitating a venous patch repair. At follow-up, there were no differences between the systolic and diastolic blood pressure or the pressure gradients between the right and left arm. Transient numbness of the right hand was observed in two patients. Permanent numbness was not observed. No patient needed further intervention or surgical revision of the RAA. Conclusions: The right axillary cannulation is feasible and safe in terms of vascular injury and brachial plexus injury with excellent in-hospital and follow-up outcome. |
| format | Article |
| id | doaj-art-423fcb9f251a4daaaa4a9c28f0af2208 |
| institution | Kabale University |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-01-01 |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-423fcb9f251a4daaaa4a9c28f0af22082025-01-24T13:36:03ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-01-011213110.3390/jcdd12010031Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass GraftingChristian Sellin0Ahmed Belmenai1Volodymyr Demianenko2Marius Grossmann3Hilmar Dörge4Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, GermanyDepartment of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, GermanyDepartment of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, GermanyDepartment of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, GermanyDepartment of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, GermanyObjective: Cardiopulmonary bypass (CPB) via the right axillary artery (RAA) has become an alternative perfusion strategy, especially in complex aortic procedures. This study delineates our technique and outcome with direct axillary cannulation utilizing the Seldinger technique, which we adopted as the standard perfusion strategy in the sternum-sparing minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) using CPB. Methods: From November 2019 to December 2023, a total of 413 consecutive patients underwent nonemergent isolated coronary artery bypass grafting (CABG) via left anterior minithoracotomy on CPB with peripheral cannulation via the RAA and cardioplegic cardiac arrest, using this technique as a default strategy in the daily routine. All patients had multivessel coronary artery disease. The primary outcome was intraoperative cannulation-related complications (bleeding, revision, ischemia, wound healing complications). The secondary outcome was cannulation-related events during follow-up (blood pressure differences, incidence of brachial plexus injury, clinical signs of circulatory problems of arm and hand, re-interventions). Mean midterm follow-up was 18.7 ± 12.3 [1.1–51.2] months. During follow-up, 16 patients died. Overall, a total of 397 patients (344 male; 67.6 ± 9.7 [32–88]) were included for follow-up (100%). Results: The RAA was successfully cannulated in 100% of patients. A cannula size of 16 Fr was used in 34.6%, 18 Fr in 63.9% and 20 Fr in 1.5% of all patients. There was no intraoperative bleeding complication. In two patients, intraoperative revision of the RAA was required, necessitating a venous patch repair. At follow-up, there were no differences between the systolic and diastolic blood pressure or the pressure gradients between the right and left arm. Transient numbness of the right hand was observed in two patients. Permanent numbness was not observed. No patient needed further intervention or surgical revision of the RAA. Conclusions: The right axillary cannulation is feasible and safe in terms of vascular injury and brachial plexus injury with excellent in-hospital and follow-up outcome.https://www.mdpi.com/2308-3425/12/1/31minimally invasive cardiac surgerycoronary artery bypass graftingCABGcardiopulmonary bypassperipheral cannulation |
| spellingShingle | Christian Sellin Ahmed Belmenai Volodymyr Demianenko Marius Grossmann Hilmar Dörge Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting Journal of Cardiovascular Development and Disease minimally invasive cardiac surgery coronary artery bypass grafting CABG cardiopulmonary bypass peripheral cannulation |
| title | Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting |
| title_full | Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting |
| title_fullStr | Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting |
| title_full_unstemmed | Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting |
| title_short | Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting |
| title_sort | direct axillary artery cannulation as standard perfusion strategy in minimally invasive coronary artery bypass grafting |
| topic | minimally invasive cardiac surgery coronary artery bypass grafting CABG cardiopulmonary bypass peripheral cannulation |
| url | https://www.mdpi.com/2308-3425/12/1/31 |
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