Initial Experience with Axillary Artery Cannulation via Deltopectoral Groove and Selective Antegrade Cerebral Perfusion for Surgery of the Ascending Aorta

Background: Arterial access for cardiopulmonary bypass in proximal aorta surgery is usually performed via the femoral, subclavian, or innominate arteries. We present our initial experience with axillary cannulation performed via the deltopectoral groove, with selective antegrade cerebral perfusion.

Methods: Included are 10 consecutive patients who underwent replacement of the ascending aorta with or without hemiarch: Type A dissection in 4, aortic aneurysm in 6.

The right axillary artery is exposed with a deltopectoral groove incision. After division of the pectoralis minor muscle and avoidance of the brachial plexus, an 8-mm graft is sewn end-to-side to the axillary artery and then cannulated with a 22F Arterial cannula. Cardiopulmonary bypass is attained via right axillary artery and right atrium. After systemic cooling, the innominate artery is clamped and selective antegrade cerebral perfusion initiated at a flow of 10cc/kg/minute, with perfusion pressure around 60 mm/hg. Cerebral O2sat is used to monitor brain perfusion. Once replacement of the ascending aorta is complete the arterial clamp is removed and systemic perfusion is renewed.

Results: Average systemic ischemic time was 36 minutes (range 24-60). All patients made a non-eventful recovery, with no incidence of stroke. Patients received an average of 4.4 units of packed RBC (range 2-10). Mean length of stay was 11 days (range 7-26).

Conclusions: Arterial access using the right axillary artery via the right delto-pectoral groove is simple and convenient. This artery is seldom involved in the disease process, and is reliably accessible, thus overcoming some of the major pitfalls of other venues. This method allows for cerebral perfusion thus reducing the risk of stroke. We have adopted this route as our preferred method for arterial cannulation for ascending aortic surgery.