Midterm Results of Axilloaxillary Cardiopulmonary Bypass

Authors

  • Altug Tuncer
  • Taylan Adademir
  • Eylem Tuncer
  • Serpil Gezer Tas
  • Arzu Antal Donmez
  • Hasan Sunar
  • Mehmet Balkanay

DOI:

https://doi.org/10.1532/HSF98.20111094

Abstract

Background: Total axilloaxillary cardiopulmonary bypass (CPB) is an alternative peripheral cannulation technique that has the advantages of antegrade flow during CPB, monohemispherical brain perfusion in case of circulatory arrest, and achieving excellent decompression of the heart during sternotomy. The results of this strategy, particularly beyond the immediately postoperative period, are not well known.

Methods: Eleven patients with huge aortic aneurysms (>80 mm) and/or acute-subacute ascending aorta dissections underwent surgery with totally axilloaxillary CPB. Short- and midterm outcomes, including survival and complications relating to axilloaxillary cannulation, were reported.

Results: All attempts at axillary artery cannulation were successful. Ten of the 11 axillary vein cannulation attempts were successful, and the target pump flow was achieved via the axillary vein alone. Postoperatively, clinical examinations revealed no cases of arm ischemia or compartment syndrome. Three patients (27.3%) experienced ipsilateral brachial plexus neuropathy that produced right hand weakness. The neuropathy was transient in 2 patients, and the symptoms resolved completely. Hospital death occurred in 1 (9.1%) of the 11 patients. The mean (±SD) follow-up time was 956 ± 292 days. One of the survivors died on postoperative day 105 from subacute graft infection and sepsis. The right arms of all 9 of the living patients were examined physically and by Doppler ultrasonography. We found a chronic recanalized thrombotic change in the subclavian vein in 1 patient (11.1%), who had no complaints.

Conclusions: Axilloaxillary CPB is an alternative technique that can be used under certain conditions. Adding axillary venous cannulation to axillary artery cannulation at least does not increase the risk of a procedure that uses the axillary artery alone, either in the early or mid term.

References

Bichell DP, Balaguer JM, Aranki SF, et al. 1997. Axilloaxillary cardiopulmonary bypass: a practical alternative to femorofemoral bypass. Ann Thorac Surg 64:702-5.nGarrnet HE Jr, Matthews J. 1989. Reoperative median sternotomy. Ann Thorac Surg 48:305.nGates JD, Bichell DP, Rizzo RJ, Couper GS, Donaldson MC. 1996. Thigh ischemia complicating femoral vessel cannulation for cardiopulmonary bypass. Ann Thorac Surg 61:730-3.nStrauch JT, Spielvogel D, Lauten A, et al. 2004. Axillary artery cannulation: routine use in ascending aorta and aortic arch replacement. Ann Thorac Surg 78:103-8.nTiwari KK, Murzi M, Bevilacqua S, Glauber M. 2010. Which cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery? Interact Cardiovasc Thorac Surg 10:797-802.nvon Segesser LK, Ferrari E, Delay D, Maunz O, Horisberger J, Tozzi P. 2008. Routine use of self-expanding venous cannulas for cardiopulmonary bypass: benefits and pitfalls in 100 consecutive cases. Eur J Cardiothorac Surg 34:635-40.nWong DR, Coselli JS, Palmero L, et al. 2010 Axillary artery cannulation in surgery for acute or subacute ascending aortic dissections. Ann Thorac Surg 90:731-8.nZattera G, Totaro P, D'Armini AM, Vigano M. 2009. Deltoido-pectoralis approach to axillary vessels for full-flow cardiopulmonary bypass. Eur J Cardiothorac Surg 35:913-4.n

Published

2012-02-23

How to Cite

Tuncer, A., Adademir, T., Tuncer, E., Tas, S. G., Donmez, A. A., Sunar, H., & Balkanay, M. (2012). Midterm Results of Axilloaxillary Cardiopulmonary Bypass. The Heart Surgery Forum, 15(1), E23-E27. https://doi.org/10.1532/HSF98.20111094

Issue

Section

Articles

Most read articles by the same author(s)