Axillary venous drainage in redo aortic root surgery

Abstract

The axillary artery is an established alternative cannulation site for peripheral cardiopulmonary bypass (CPB). However, axillary vein cannulation is not as common. Here, we present our experience with an axillo‐axillary CPB combined with a femoro‐femoral CPB in redo aortic root replacement. The full‐flow bypass was obtained with vacuum‐assisted drainage and excellent decompression of the heart was achieved without left heart venting. Although only adhesions around the aortic root graft were dissected, a comfortable surgical field could be obtained with our CPB strategy. Axillary vessels were easy to expose with a small single skin incision. Cerebral protection could be achieved in both antegrade and retrograde fashion when the circulatory arrest was required for an additional arch procedure. Our strategy based on axillo‐axillary and femoro‐femoral CPB was effective and feasible in redo aortic root replacement. We consider that it simplified the complex aortic reoperation.

Simple Redo Proximal Thoracic Aortic Surgery with Peripheral Cardiopulmonary Bypass and Minimal Dissection

“…Additionally, the axillary arterial and venous cannulation allows for both antegrade and retrograde cerebral perfusion when an additional aortic arch procedure with circulatory arrest is necessary. 4,5) However, inadequate venous drainage and cardiac distension during the cooling phase are major concerns with the peripheral CPB strategy. Modern femoral venous cannulas with multiple holes usually provide sufficient drainage for full-flow CPB in minimally invasive cardiac surgery.…”

“…2). 4) No venous cannula was placed on the surface of the right atrium. The femoral vein was cannulated using a guidewire technique and the tip of the cannula was placed in the right atrium.…”