Direct axillary artery cannulation in cardiac surgery: clinical outcomes.

Objective Axillary artery cannulation is still regarded with distrust by surgeons because the artery is supposed to be fragile, difficult to access, and its cannulation is often considered time-consuming. This study was carried out to assess our results in a series of patients, using a simplified surgical approach to axillary artery cannulation. Methods Data were collected retrospectively from our prospective database. All patients operated on in our department between January 2004 and October 2016 and scheduled for various cardiac procedures with direct axillary artery cannulation were included in this study. In this twelve-year period, 246 patients had direct axillary artery cannulation during a cardiac surgical procedure. The mean age was 67.3 ± 14.7 years. The artery was approached at the level of the deltopectoral groove and cannulated by the direct Seldinger technique. Results The main indications for axillary artery cannulation were: right minithoracotomy aortic valve replacement ( n = 93), aortic dissection ( n = 57), extracorporeal life support ( n = 36), transarterial valve replacement ( n = 27), ascending aortic aneurysm ( n = 16), and others ( n = 17). The cannulation was right-sided in 90.6% of patients. Axillary cannulation-related morbidity was 6.1%. Axillary cannulation-related mortality was 0.8% (2 patients). Conclusions The axillary artery is a reliable site for rapid cannulation, carrying a low risk of morbidity and mortality. Our findings show that this artery is solid and can be very useful in everyday cardiac surgical practice.

Results of elective cardiac surgery in patients with severe obesity (body mass index≥35 kg/m2).

BACKGROUND: The increasing number of obese patients eligible for cardiac surgery requires risks and benefits to be balanced in this population. AIMS: To study the results of cardiac surgery in severely obese patients (body mass index [BMI]≥35 kg/m2). METHODS: In this retrospective study of 3564 patients undergoing elective cardiac surgery between 2004 and 2012, the population was divided into two groups: BMI 20-34.9 kg/m2 (n=3282) and BMI≥35 kg/m2 (n=282). Patients with BMI<20 kg/m2 were excluded due to the well-known increased mortality risk. The primary endpoint was 90-day mortality. A multivariable analysis was performed to identify prognostic factors. RESULTS: Among our patients, 58.2% and 27.7% underwent isolated coronary or valvular surgery, respectively; 9.7% had combined valvular and coronary surgery and 4.4% had other procedures. Severely obese patients were younger: 62.5±9.3 years vs 67.8±10.7 years (P=0.0001). Overall 90-day mortality was 4.0%. Severe obesity did not influence postoperative mortality. In the multivariable analysis, the interaction between preoperative renal failure and severe obesity was an important mortality prognostic factor (hazard ratio: 11.17; P=0.03). Mediastinitis rates were similar between groups in non-diabetic patients; in diabetic patients, severe obesity was associated with higher mediastinitis rates (P=0.002). Superficial wound infections were higher in severely obese patients (P=0.003). CONCLUSION: Elective cardiac surgery in severely obese patients was not associated with increased perioperative morbimortality, but had a higher superficial wound infection risk. Nevertheless, severe obesity itself should not be a contraindication to elective surgery.

Extracorporeal membrane oxygenation with direct axillary artery perfusion.

Extracorporeal membrane oxygenation can be done through several cannulation sites. Axillary artery cannulation is commonly performed through a Dacron graft sutured in an end-to-side fashion to the axillary artery. Direct cannulation of the axillary artery appears a reliable technique with low rate of complications. We report our experience in 16 patients using the direct cannulation technique.

Long-term results of the bentall operation versus separate replacement of the ascending aorta and aortic valve.

BACKGROUND AND AIMS OF THE STUDY: Aortic valve disease associated with ascending aorta dilatation can be treated either by separate replacement of the aortic valve and ascending aorta, or by a composite valved graft. METHODS: Between 1974 and 1999, 117 patients underwent a Bentall operation (BP), and 63 a separate replacement procedure (SP) of the ascending aorta and aortic valve. Anatomic lesions were dystrophic aneurysm in 79 patients, annuloectasia in 65, chronic dissection in 14, acute dissection in 18, and other etiology in four. Mean follow up was 3.45+/-3.47 and 8.75+/-6.8 years in the BP and SP groups, respectively. RESULTS: Early mortality was 7.7% in the BP group versus 11% in the SP group (p = NS). Actuarial survival at 10 years postoperatively in these groups was respectively 77.7+/-5.6% versus 75.8+/-6.9% (p = NS). However, freedom from late complication of the ascending aorta was significantly different (97.3+/-1.9% versus 68.3+/-9.0% at 10 years postoperatively). SP was identified as a risk factor for late complication of the ascending aorta by multivariate analysis (p = 0.01; odds ratio = 9). No statistical difference was observed on late reoperation rates. CONCLUSION: Separate replacement of the ascending aorta and aortic valve carries a higher complication rate for the remaining ascending aorta on long-term follow up when compared with the Bentall procedure. However, there were no differences in terms of late mortality.