{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:03:16Z","timestamp":1791633796244,"version":"4.3.4"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,18]],"date-time":"2025-01-18T00:00:00Z","timestamp":1737158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Objective: Cardiopulmonary bypass (CPB) via the right axillary artery (RAA) has become an alternative perfusion strategy, especially in complex aortic procedures. This study delineates our technique and outcome with direct axillary cannulation utilizing the Seldinger technique, which we adopted as the standard perfusion strategy in the sternum-sparing minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) using CPB. Methods: From November 2019 to December 2023, a total of 413 consecutive patients underwent nonemergent isolated coronary artery bypass grafting (CABG) via left anterior minithoracotomy on CPB with peripheral cannulation via the RAA and cardioplegic cardiac arrest, using this technique as a default strategy in the daily routine. All patients had multivessel coronary artery disease. The primary outcome was intraoperative cannulation-related complications (bleeding, revision, ischemia, wound healing complications). The secondary outcome was cannulation-related events during follow-up (blood pressure differences, incidence of brachial plexus injury, clinical signs of circulatory problems of arm and hand, re-interventions). Mean midterm follow-up was 18.7 \u00b1 12.3 [1.1\u201351.2] months. During follow-up, 16 patients died. Overall, a total of 397 patients (344 male; 67.6 \u00b1 9.7 [32\u201388]) were included for follow-up (100%). Results: The RAA was successfully cannulated in 100% of patients. A cannula size of 16 Fr was used in 34.6%, 18 Fr in 63.9% and 20 Fr in 1.5% of all patients. There was no intraoperative bleeding complication. In two patients, intraoperative revision of the RAA was required, necessitating a venous patch repair. At follow-up, there were no differences between the systolic and diastolic blood pressure or the pressure gradients between the right and left arm. Transient numbness of the right hand was observed in two patients. Permanent numbness was not observed. No patient needed further intervention or surgical revision of the RAA. Conclusions: The right axillary cannulation is feasible and safe in terms of vascular injury and brachial plexus injury with excellent in-hospital and follow-up outcome.<\/jats:p>","DOI":"10.3390\/jcdd12010031","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T09:11:13Z","timestamp":1737364273000},"page":"31","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Direct Axillary Artery Cannulation as Standard Perfusion Strategy in Minimally Invasive Coronary Artery Bypass Grafting"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8485-0024","authenticated-orcid":false,"given":"Christian","family":"Sellin","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Belmenai","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5887-9949","authenticated-orcid":false,"given":"Volodymyr","family":"Demianenko","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Grossmann","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilmar","family":"D\u00f6rge","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, 36043 Fulda, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/S0022-5223(95)70312-8","article-title":"Axillary artery: An alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease","volume":"109","author":"Sabik","year":"1995","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/S0003-4975(02)04497-1","article-title":"Cannulation of the axillary artery for cardiopulmonary bypass: Safeguards and pitfalls","volume":"75","author":"Sinclair","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/S1010-7940(02)00365-2","article-title":"Axillary artery cannulation in surgery of the ascending aorta and the aortic arch","volume":"22","author":"Schachner","year":"2002","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_4","first-page":"133","article-title":"Dissection aortique aigu\u00eb totale de type I. Int\u00e9r\u00eat de la perfusion art\u00e9rielle par voie axillaire [Type I, complete, acute aortic dissection. Value of arterial perfusion by the axillary route (author\u2019s transl)]","volume":"15","author":"Villard","year":"1976","journal-title":"Ann. Chir. Thorac. Cardiovasc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.athoracsur.2022.02.048","article-title":"Direct Axillary Artery Cannulation for Aortic Surgery: Lessons from Contemporary Experiences","volume":"114","author":"Ohira","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/j.athoracsur.2003.08.056","article-title":"Cannulation of the axillary artery with a side graft reduces morbidity","volume":"77","author":"Sabik","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1016\/j.athoracsur.2020.12.022","article-title":"Direct Versus Side Graft Cannulation From the Right Axillary Artery in Thoracic Aortic Surgery","volume":"112","author":"Puiu","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.athoracsur.2004.01.035","article-title":"Axillary artery cannulation: Routine use in ascending aorta and aortic arch replacement","volume":"78","author":"Strauch","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1016\/j.athoracsur.2021.05.008","article-title":"Direct Axillary Artery Cannulation for Type A Dissection and Impact of Dissected Innominate Artery","volume":"113","author":"Ohira","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.ejcts.2004.12.042","article-title":"Technical problems and complications of axillary artery cannulation","volume":"27","author":"Schachner","year":"2005","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1093\/ejcts\/ezx394","article-title":"Direct axillary cannulation with open Seldinger-guided technique: Is it safe?","volume":"53","author":"Carino","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.jtcvs.2012.08.070","article-title":"Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation","volume":"145","author":"Chamogeorgakis","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"368","DOI":"10.3109\/00016925309136722","article-title":"Catheter replacement of the needle in percutaneous arteriography; a new technique","volume":"39","author":"Seldinger","year":"1953","journal-title":"Acta Radiol."},{"key":"ref_14","first-page":"330","article-title":"Complete Coronary Revascularization via Left Anterior Thoracotomy","volume":"14","author":"Babliak","year":"2019","journal-title":"Innovations"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1007\/s00380-022-02034-x","article-title":"Novel concept of routine total arterial coronary bypass grafting through a left anterior approach avoiding sternotomy","volume":"37","author":"Sellin","year":"2022","journal-title":"Heart Vessel."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s00392-015-0932-2","article-title":"Description of a Heart Team approach to coronary revascularization its beneficial long-term effect on clinical events after PCI","volume":"105","author":"Bonzel","year":"2016","journal-title":"Clin. Res. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/ejcts\/ezy289","article-title":"ESC Scientific Document Group 2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"55","author":"Neumann","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1055\/s-0042-1758149","article-title":"Early Results of Total Coronary Revascularization via Left Anterior Thoracotomy","volume":"71","author":"Sellin","year":"2023","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1093\/icvts\/ivt056","article-title":"Liberal use of axillary artery cannulation for aortic and complex cardiac surgery","volume":"16","author":"Fong","year":"2013","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.ejcts.2004.04.032","article-title":"Advantages of subclavian artery perfusion for repair of acute type A dissection","volume":"26","author":"Reuthebuch","year":"2004","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.athoracsur.2004.04.063","article-title":"Does the arterial cannulation site for circulatory arrest influence stroke risk?","volume":"78","author":"Svensson","year":"2004","journal-title":"Ann. Thorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1016\/j.hlc.2010.08.007","article-title":"Axillary artery cannulation for aortic and complex cardiac surgery","volume":"19","author":"Bassin","year":"2010","journal-title":"Heart Lung Circ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.jtcvs.2004.01.013","article-title":"Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli","volume":"128","author":"Hedayati","year":"2004","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1007\/s00380-015-0704-y","article-title":"Axillary artery cannulation provides balanced cerebral oxygenation","volume":"31","author":"Hillebrand","year":"2016","journal-title":"Heart Vessel."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.jtcvs.2013.02.023","article-title":"Anatomic and flow dynamic considerations for safe right axillary artery cannulation","volume":"146","author":"Hillebrand","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.jtcvs.2017.02.073","article-title":"Computational fluid dynamics simulation of the right subclavian artery cannulation","volume":"154","author":"Numata","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E157","DOI":"10.59958\/hsf.7173","article-title":"Direct Right Axillary Artery Cannulation as First Choice Strategyduring Aortic Surgery Procedures: Results from a Single Experienced Surgical Centre","volume":"27","author":"Totaro","year":"2024","journal-title":"Heart Surg. Forum"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"5622","DOI":"10.1111\/jocs.17220","article-title":"An alternate approach: Percutaneous axillary cannulation for minimally invasive cardiac surgery","volume":"37","author":"Mandel","year":"2022","journal-title":"J. Card. 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