Redo Axillary Artery Cannulation in Reoperative Cardiac Surgery: Outcomes and Technique

Abstract

Background

Reoperative sternotomy often necessitates peripheral arterial cannulation to initiate systemic or cerebral perfusion. In patients with prior right axillary cannulation, the site can be reused by anastomosing a new Dacron graft at, proximal to, or distal to the original anastomosis. Axillary cannulation provides reliable systemic perfusion while avoiding the embolic risks of femoral access and technical challenges of central cannulation in the redo setting. However, outcomes after redo axillary cannulation are sparsely reported, and the safety of this approach is not well defined.

Methods

We retrospectively reviewed 55 consecutive patients (2008-2025) who underwent redo axillary cannulation for cardiopulmonary bypass during complex adult cardiac surgery at a single high-volume aortic referral center. Thirty-day/in-hospital outcomes were recorded, and operative technique was described. Redo cannulation involved anastomosis of a Dacron side-arm graft at the prior site or immediately adjacent along the axillary artery.

Results

In 55 patients (mean age, 58.9 years; 72.7% male), redo axillary cannulation was performed a median of 4.6 years after the original operation. The most common indications for reoperation were aneurysm (60.0%) and structural valve degeneration (23.6%). Thirty-day mortality was 1.8%, and perioperative stroke occurred in 3.6% (n = 2). Ipsilateral upper extremity neurovascular complications were uncommon (3.6%), and no wound complications were observed.

Conclusions

Redo axillary cannulation is technically feasible and safe, with low rates of stroke, neurovascular injury, and no wound complications in this series. Prior axillary cannulation should not preclude reuse of the artery, offering a reliable alternative when central or femoral cannulation is undesirable.