Redo axillary artery cannulation in aortic reoperations: Technical variations and implications for optimal outcomesCentral MessagePerspective
Objectives: Recannulation of the right axillary artery (Redo-AX) is a valuable yet underutilized technique in aortic reoperations. The present study sought to analyze the outcomes of 1 of the largest redo AX cannulations experiences. Methods: From February 2005 to December 2024, AX cannulation was p...
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Elsevier
2025-08-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250725002378 |
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| author | Suguru Ohira, MD, PhD Gabrielle Amar, BA Sooyun Caroline Tavolacci, MD, MSCR Masashi Kai, MD Ramin Malekan, MD Junichi Shimamura, MD, PhD Steven L. Lansman, MD, PhD David Spielvogel, MD |
| author_facet | Suguru Ohira, MD, PhD Gabrielle Amar, BA Sooyun Caroline Tavolacci, MD, MSCR Masashi Kai, MD Ramin Malekan, MD Junichi Shimamura, MD, PhD Steven L. Lansman, MD, PhD David Spielvogel, MD |
| author_sort | Suguru Ohira, MD, PhD |
| collection | DOAJ |
| description | Objectives: Recannulation of the right axillary artery (Redo-AX) is a valuable yet underutilized technique in aortic reoperations. The present study sought to analyze the outcomes of 1 of the largest redo AX cannulations experiences. Methods: From February 2005 to December 2024, AX cannulation was planned for 804 aortic repairs and analyzed according to the intention-to-treat principle. Fifty patients had Redo-AX, whereas 754 patients had primary AX cannulation. Cannulation-related events included technical failure, vascular injury, additional vascular rep, and iatrogenic retrograde dissection. Results: This cohort included 196 redo sternotomies (24.4%) and 381 type A aortic dissections (47.4%). Among the 50 Redo-AX procedures, 46 patients had direct AX cannulation, and 4 patients had the side-graft technique in their initial surgery. Forty-five patients were successfully cannulated for cardiopulmonary bypass. Two patients underwent the side-graft technique with a graft extension, and direct AX cannulation was performed in 43 patients via arteriotomy (n = 40), the Seldinger technique (n = 2), and direct cannulation through an old polyethylene terephthalate graft (n = 1). The overall rate of cannulation-related events was 2.1% (17 out of 804), and the rate of cannulation site shift was 2.7% (22 out of 804). Cannulation-related events (10% vs 1.6%; P < .001) were significantly more common in the Redo-AX group. Operative mortality was comparable between groups (Redo-AX, 0% vs Primary-AX, 4.8%; P = .220), as was the incidence of stroke (0% vs 4.9%, P = .209). Conclusions: Redo-AX is a durable approach for complex redo aortic cases. Careful preoperative evaluation and certain surgical expertise are paramount to achieving optimal outcomes. |
| format | Article |
| id | doaj-art-0e66a6230a8f4d28bd4cd870f1cb5d71 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | JTCVS Techniques |
| spelling | doaj-art-0e66a6230a8f4d28bd4cd870f1cb5d712025-08-20T03:36:44ZengElsevierJTCVS Techniques2666-25072025-08-01321910.1016/j.xjtc.2025.05.017Redo axillary artery cannulation in aortic reoperations: Technical variations and implications for optimal outcomesCentral MessagePerspectiveSuguru Ohira, MD, PhD0Gabrielle Amar, BA1Sooyun Caroline Tavolacci, MD, MSCR2Masashi Kai, MD3Ramin Malekan, MD4Junichi Shimamura, MD, PhD5Steven L. Lansman, MD, PhD6David Spielvogel, MD7Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY; Department of Cardiothoracic Surgery, New York Medical College, Valhalla, NY; Department of Cardiac Surgery, Hartford Hospital, Hartford, Conn; Address for reprints: Suguru Ohira, MD, PhD, Department of Cardiac Surgery, Hartford Hospital, 85 Seymour St, Suite 919, Hartford, CT 06106.Department of Cardiothoracic Surgery, New York Medical College, Valhalla, NYDivision of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NYDivision of Cardiac Surgery, Boston Deaconess Medical Center, Boston, MassDivision of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY; Department of Cardiothoracic Surgery, New York Medical College, Valhalla, NYDivision of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY; Department of Cardiothoracic Surgery, New York Medical College, Valhalla, NYDivision of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY; Department of Cardiothoracic Surgery, New York Medical College, Valhalla, NYDivision of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY; Department of Cardiothoracic Surgery, New York Medical College, Valhalla, NYObjectives: Recannulation of the right axillary artery (Redo-AX) is a valuable yet underutilized technique in aortic reoperations. The present study sought to analyze the outcomes of 1 of the largest redo AX cannulations experiences. Methods: From February 2005 to December 2024, AX cannulation was planned for 804 aortic repairs and analyzed according to the intention-to-treat principle. Fifty patients had Redo-AX, whereas 754 patients had primary AX cannulation. Cannulation-related events included technical failure, vascular injury, additional vascular rep, and iatrogenic retrograde dissection. Results: This cohort included 196 redo sternotomies (24.4%) and 381 type A aortic dissections (47.4%). Among the 50 Redo-AX procedures, 46 patients had direct AX cannulation, and 4 patients had the side-graft technique in their initial surgery. Forty-five patients were successfully cannulated for cardiopulmonary bypass. Two patients underwent the side-graft technique with a graft extension, and direct AX cannulation was performed in 43 patients via arteriotomy (n = 40), the Seldinger technique (n = 2), and direct cannulation through an old polyethylene terephthalate graft (n = 1). The overall rate of cannulation-related events was 2.1% (17 out of 804), and the rate of cannulation site shift was 2.7% (22 out of 804). Cannulation-related events (10% vs 1.6%; P < .001) were significantly more common in the Redo-AX group. Operative mortality was comparable between groups (Redo-AX, 0% vs Primary-AX, 4.8%; P = .220), as was the incidence of stroke (0% vs 4.9%, P = .209). Conclusions: Redo-AX is a durable approach for complex redo aortic cases. Careful preoperative evaluation and certain surgical expertise are paramount to achieving optimal outcomes.http://www.sciencedirect.com/science/article/pii/S2666250725002378aortareoperationaxillary artery |
| spellingShingle | Suguru Ohira, MD, PhD Gabrielle Amar, BA Sooyun Caroline Tavolacci, MD, MSCR Masashi Kai, MD Ramin Malekan, MD Junichi Shimamura, MD, PhD Steven L. Lansman, MD, PhD David Spielvogel, MD Redo axillary artery cannulation in aortic reoperations: Technical variations and implications for optimal outcomesCentral MessagePerspective JTCVS Techniques aorta reoperation axillary artery |
| title | Redo axillary artery cannulation in aortic reoperations: Technical variations and implications for optimal outcomesCentral MessagePerspective |
| title_full | Redo axillary artery cannulation in aortic reoperations: Technical variations and implications for optimal outcomesCentral MessagePerspective |
| title_fullStr | Redo axillary artery cannulation in aortic reoperations: Technical variations and implications for optimal outcomesCentral MessagePerspective |
| title_full_unstemmed | Redo axillary artery cannulation in aortic reoperations: Technical variations and implications for optimal outcomesCentral MessagePerspective |
| title_short | Redo axillary artery cannulation in aortic reoperations: Technical variations and implications for optimal outcomesCentral MessagePerspective |
| title_sort | redo axillary artery cannulation in aortic reoperations technical variations and implications for optimal outcomescentral messageperspective |
| topic | aorta reoperation axillary artery |
| url | http://www.sciencedirect.com/science/article/pii/S2666250725002378 |
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