Safety and Feasibility of Axillary Artery Cannulation In Robotic Assisted Minimally Invasive Coronary Revascularization

Purpose: Axillary artery cannulation is associated with safer results and fewer complications compared to femoral artery cannulation in minimally invasive cardiac surgery. Coronary artery bypass surgery patients present with a high atherosclerotic burden, and thus may also benefit greatly from antegrade axillary artery cannulation. The aim of this study was to compare outcomes in axillary and femoral cannulation in robotic-assisted minimally invasive coronary artery bypass surgery.Methods: Between March 2022 and May 2024, 96 consecutive patients underwent on-pump robotic-assisted minimally invasive coronary artery bypass surgery at our institution. Preoperative computed tomography scans were assessed for atherosclerosis to guide cannulation strategy. Axillary cannulation was performed in 57 (59.4%) patients and femoral cannulation in 39 (40.6%) patients. Patient demographics and perioperative data were retrospectively analyzed. The primary endpoint of the study was peri-operative complications including stroke and in-hospital mortality.Results: There were no cases of post-operative mortality or stroke in either group. No complications including hematomas, cannulation site infections, emboli, dissection, neurovascular injury or brachial plexus injuries were observed in either group. No other complications were encountered in femoral cannulation patients except for seromas at the cannulation site in 3 (7.7%) of the patients.Conclusions: Direct cannulation of the axillary artery is a safe method for establishment of cardiopulmonary bypass in robotic-assisted minimally invasive coronary revascularization patients. This approach can benefit patients with severe peripheral arterial and aortic calcification or thrombi with safe outcomes in robotic-assisted minimally invasive coronary revascularization.