Atherosclerotic aneurysm repair of the ascending aorta and aortic root: Does axillary cannulation improve neurological outcome?

Objective: Axillary artery cannulation (AxC) is increasingly being utilized for ascending aorta/root repair, but its impact on neurological outcome remains somewhat controversial. A retrospective evaluation of the influence of AxC on outcome after surgery for ascending aortic disease of different etiologies was undertaken.

Methods: More than 600 cases of ascending aorta/root repairs (1995–2006), principally for atherosclerotic aneurysms (15%), degenerative aneurysms (64%) and chronic type-A dissections (12%), were reviewed. Arterial cannulation was accomplished directly via the ascending aorta (AAC) in 19% of patients, via the femoral artery (FAC) in 37%, and via the right axillary artery (AxC) in 44% of patients. Patients cannulated at different sites were compared with regard to preoperative co-morbidities, and outcomes-mortality and complications – for each etiology.

Results: In patients with atherosclerotic aneurysms right AxC was utilized in 55% of cases and was associated with a significantly better neurological outcome (p=0.04): 100% of patients with AxC survived (FAC-95%; AAC-93%), 4% suffered strokes (FAC-9%; AAC-7%). Only 11% of the patients with AxC had temporary neurological deficits (FAC-26%; AAC-20%). In contrast, no significant advantage for AxC was found with ascending aortic surgery for chronic type A dissection (p=n.s.), degenerative aneurysm (p=n.s.), endocarditis or other etiologies (p=n.s.).

Conclusions: AxC results in superior neurological outcome in patients with atherosclerotic aneurysms. Outcomes are not significantly better than with cannulation at other sites during ascending aortic surgery for degenerative aneurysms and chronic dissections. This study supports the use of AxC in all patients with atherosclerotic disease who require complex cardiothoracic surgery.