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.