Femoral artery versus right axillary artery cannulation in various cardiac procedures, a single center experience: The quest for the holy grail

Background

There are many arterial cannulation sites to establish cardiopulmonary bypass (CPB). Each site has its advantages and disadvantages. Organ malperfusion especially the cerebral malperfusion during CPB is the most critical outcome in comparing different arterial sites. We aimed to evaluate safety and efficacy of axillary and femoral arterial cannulation in various situations.

Methods

This retrospective observational study, included 75 patients underwent redo valve surgery or denovo thoracic aorta surgery. Patients were reviewed in terms of organ malperfusion namely brain and kidney; and cannulation site related complications. Patients were divided into two groups Femoral group (n = 46) and Axillary group (n = 29).

Results

The mortality in the femoral group was 4.35%, while the axillary group showed a 3.45% mortality; without statistically significant difference. The axillary group had a significantly lower total hospital stay (p value 0.002), and highly significant lower ventilation hours (p value < 0.001). Other post-operative complications were lower in the axillary groups, without reaching statistical significance.

Conclusions

Both axillary and femoral artery cannulation provide a safe quick route for establishing CBP support in critical conditions before opening the chest. The axillary route is more technically demanding while the femoral route is handier in such cases. Individual arterial cannulation strategy should be done for each patient with a backup plan.