Eastern Cardiothoracic Surgical Society

The Use of Axillary Cannulation in Re-Do Cardiac Surgery Utilizing Port Access Technology
Tyler J. Wallen1, Prashanth Vallabhajosyula2, Lauren Solometo2, W. Clarke Hargrove, III2. 1Mercy Catholic Medical Center, Darby, PA USA, 2University of Pennsylvania Health System, Philadelphia, PA USA.


Objective: Re-do cardiac surgery via port access technology has been described by several centers. Patients requiring re-do surgery often have significant comorbidities, including significant vascular disease which can make standard cannulation difficult. This study compares clinical outcomes of patients undergoing redo cardiac surgery via a port access approach with axillary cannulation to those with femoral cannulation.

Methods: From 2002-2015, patients undergoing redo cardiac surgery via a port access approach were divided into those receiving axillary arterial cannulation (Group 1, n=11) and those receiving femoral cannulation (Group 1, n=90).

Results: Group 1 was older (73 years in group 1, 64 in group 2, p=<0.05). Other demographics were similar (Table SA15-1). Cardiopulmonary bypass time was similar (CBP: 133, 152 min, p=NS), however, cross clamp time was longer in group 2 (cross clamp: 44, 90 min, p=<0.05). Sternotomy conversion rate was similar in both groups (0%, 4%, p=NS). Death, stroke, aortic dissection, transfusion requirement, and wound infection rates were similar (death: 0%, 3%; stroke: 0%, 1%; aortic dissection: 9%, 3%; transfusion requirement: 55%, 47%; wound infection: 0%, 1%, p=NS in all categories). Reoperation rate for bleeding and for valvular indications was similar (bleeding reoperations: 0%, 6%; valve reoperations: 0%, 2%, p=NS) (Table SA15-2).

Conclusions: Outcomes in patients undergoing redo cardiac surgery via a port access approach with axillary cannulation are equivocal to those who receive femoral cannulation. Axillary cannulation is a suitable option in patients with vascular disease prohibitive of standard cannulation.

Table 1 – Demographics
Preoperative Characteristics Group 1 (n=11) Group 2 (n=90) P
Age (years) 73 +/- 7 64 +/- 14 0.0484
Male 6 (55%) 56 (62%) 0.5058
NYHA >2 8 (73%) 58 (64%) 0.4874
Ejection Fraction (%) 48 +/- 14 47 +/- 14 0.8308
Table 2 – Operative Data and Clinical Outcomes
Operative Data Group 1 (n=11) Group 2 (n=90) P
MVR 5 (45%) 39 (43%) 1
MV Repair 6 (55%) 45 (50%) 1
Other 0 (0%) 6 (7%) 1
Cross Clamp Time (min) 44 +/- 45 90 +/- 49 0.0055
CPB Time (min) 133 +/- 33 152 +/- 47 0.2172
Conversion to Sternotomy 0 (0%) 4 (4%) 1
Clinical Outcomes Group 1 (n=11) Group 2 (n=90) P
Death 0 (0%) 3 (3%) 1
Stroke 0 (0%) 1 (1%) 1
Aortic Dissection 1 (9%) 3 (3%) 0.3742
Wound Infection 0 (0%) 1 (1%) 1
Transfusion Requirement 6 (55%) 42 (47%) 0.7527
Reop for Bleeding 0 (0%) 5 (6%) 1
Redo Valve Surgery 0 (0%) 2 (2%) 1