Direct Axillary Artery Cannulation for Aortic Surgery: Lessons From Contemporary Experiences

Ohira, Suguru; Kai, Masashi; Goldberg, Joshua; Malekan, Ramin; Lansman, Steven L.; Spielvogel, David

doi:10.1016/j.athoracsur.2022.02.048

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…This is in the safe limit of unilateral ACP under moderate or deep hypothermia (<50 minutes) described in the study by Angleitner and colleagues. 23 The overall stroke rate (15.6%) in this study was higher than in our previous series of all ATAD repairs (4.6%-8.4% including submitting data), 16 , 24 which is likely due to a high prevalence of neck vessels dissection and cerebral malperfusion in patients who underwent Zone 2 arch repair. 10 , 11 , 12 Another interesting result is that arch or ascending arch tear was higher in the arch-first group.…”

Section: Discussioncontrasting

confidence: 58%

“…In this setting, some patients require clamping of the ascending graft and bifurcated graft because proximal anastomosis of the bifurcated graft is located just above the sinotubular junction. Bilateral axillary cannulation is an effective option ( Figure E2 ), 24 and left CCA to left subclavian bypass is also useful. Alternatively, Di Eusanio and colleagues 25 reported that a separate graft can be anastomosed to an 8-mm limb of a bifurcated graft after reentry to the sternum, which provides bilateral brain perfusion.…”

Section: Discussionmentioning

confidence: 99%

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Zone 2 arch repair for acute type A dissection: Evolution from arch-first to proximal-first repair

Ohira¹,

Gregory²,

Goldberg³

et al. 2023

JTCVS Techniques

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Zone 2 arch repair for acute type A dissection: Evolution from arch-first to proximal-first repair

Ohira¹,

Gregory²,

Goldberg³

et al. 2023

JTCVS Techniques

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“…Before VA-ECMO implantation, it is necessary to fully evaluate whether the artery to be intubated is affected by dissection, ensuring that the artery is supplied by the true lumen. Using the axillary artery for arterial catheterization ensures anterograde blood flow to the aorta (40)(41)(42)(43)(44)(45)(46). However, in this case, the right axillary artery was intubated for CPB, and the right femoral artery had just undergone a puncture for PCI.…”

Section: Discussionmentioning

confidence: 99%

Case report: Surgery combined with extracorporeal membrane oxygenation for a patient with type A aortic dissection complicated with myocardial infarction after percutaneous coronary intervention

Zeng³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundAortic dissection (AD) is a severe cardiovascular disease characterized by aortic rupture, aortic valve insufficiency, aortic branch lumen stenosis, and occlusion. Acute ST-segment elevation myocardial infarction may be the primary manifestation when aortic dissection affects the coronary artery, leading to delayed or missed diagnosis of aortic dissection, and preventing patients from receiving timely and comprehensive treatment. Simultaneous aortic repair and coronary artery bypass grafting surgery are controversial because of their high mortality rates. Personalized and optimal treatment plans for patients should be taken seriously based on their different conditions and treatment options.Case presentationA 42-year-old man who experienced 1 h of persistent precordialgia was admitted to a local second-level hospital for emergency treatment. Electrocardiogram (ECG) showed evidence of ST-segment elevation, and myocardial enzyme levels were CK-MB 18.35 ng/ml and troponin 0.42 ng/ml. The patient was treated for acute myocardial infarction (AMI) and urgently sent to the interventional catheter room. Coronary angiography showed stenosis of the starting part of the right coronary artery trunk. Thus, stent implantation was performed, and the stenosis section recovered patency; however, postoperative precordialgia was not alleviated. Computed tomography angiography (CTA) revealed a type A AD. The patient was immediately transferred to a higher-level hospital, underwent emergency surgery with cardiopulmonary bypass (CPB) ascending aorta replacement, SUN's procedure (total arch replacement and stented elephant trunk implantation), and simultaneous implantation of extracorporeal membrane oxygenation (ECMO), and regained consciousness within intensive care unit care. ECMO was discontinued when hemodynamics stabilized. The patient ultimately recovered well and was discharged.ConclusionThis case demonstrated that precordialgia is not limited to myocardial infarction but may also be accompanied by aortic dissection. Percutaneous coronary intervention (PCI) can timely and effectively restore coronary artery perfusion, strive for the opportunity of aortic repair surgery, and can overcome pump failure caused by myocardial infarction, cardiopulmonary bypass, heart block time, and myocardial ischemia-reperfusion injury. Personalized treatment is crucial for patients with complex type A aortic dissection.

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“…8 Gram-negative bacteria" such as P. aeruginosa and Klebsiella species, were the cause of infection in FA cannulation sites, likely due to proximity of the wound to the gastrointestinal, urinary, and genital area while there was only 1 g positive infection was seen in an AX cannulation patient. In addition to the difference in the type of bacteria contributing to infectious complication, the important anatomical aspect of the AX is the presence of the pectus major and minor muscles over the AX 8,23 which contributes to isolation of the artery away from the skin organisms. Salna and colleagues reported that a cutdown procedure is a risk factor for developing FA wound complications in heart transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Cannulation‐related adverse events of peripheral veno‐arterial extracorporeal membrane oxygenation support in heart transplantation: Axillary versus femoral artery cannulation

Ohira

Dhand

Hirani

et al. 2022

Clinical Transplantation

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Background In heart transplantation (HT), peripheral veno‐arterial extracorporeal membranous oxygenation (VA‐ECMO) is utilized preoperatively as a direct bridge to HT or postoperatively for primary graft dysfunction (PGD). Little is known about wound complications of an arterial VA‐ECMO cannulation site which can be fatal. Methods From 2009 to 2021, outcomes of 80 HT recipients who were supported with peripheral VA‐ECMO either preoperatively or postoperatively were compared based on the site of arterial cannulation: axillary (AX: N = 49) versus femoral artery (FA: N = 31). Results Patients in the AX group were older (AX: 59 years vs. 52 years, p = .006), and less likely to have extracorporeal cardiopulmonary resuscitation (0% vs. 12.9%, p = .040). Survival to discharge (AX, 81.6% vs. FA. 90.3%, p = .460), incidence of stroke (10.2% vs. 6.5%, p = .863), VA‐ECMO cannulation‐related bleeding (6.1% vs. 12.9%, p = .522), and arm or limb ischemia (0% vs. 3.2%, p = .816) were comparable. ECMO cannulation‐related wound complications were lower in the AX group (AX, 4.1% vs. FA, 45.2%, p < .001) including the wound infections (2.0% vs. 32.3%, p < .001). In FA group, all organisms were gram‐negative species. In univariate logistic regression analysis, AX cannulation was associated with less ECMO cannulation‐related wound complications (Odds ratio, .23, p < .001). There was no difference between cutdown and percutaneous FA insertion regarding cannulation‐related complications. Conclusions Given the lower rate of wound complications and comparable hospital outcomes with femoral cannulation, axillary VA‐ECMO may be an excellent option in HT candidates or recipients when possible

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Direct Axillary Artery Cannulation for Aortic Surgery: Lessons From Contemporary Experiences

Cited by 9 publications

References 17 publications

Zone 2 arch repair for acute type A dissection: Evolution from arch-first to proximal-first repair

Zone 2 arch repair for acute type A dissection: Evolution from arch-first to proximal-first repair

Case report: Surgery combined with extracorporeal membrane oxygenation for a patient with type A aortic dissection complicated with myocardial infarction after percutaneous coronary intervention

Cannulation‐related adverse events of peripheral veno‐arterial extracorporeal membrane oxygenation support in heart transplantation: Axillary versus femoral artery cannulation

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