Axillary Artery Access for Combined Endoaortic Balloon Occlusion and Perfusion During Robotic Mitral Valve Surgery.
We aimed to develop a method that provides an alternative cannulation site in robotic mitral valve surgery that allows simultaneous endo-occlusion and antegrade perfusion. A 71-year-old man with severe mitral regurgitation and history of coronary artery bypass grafting underwent totally endoscopic robotic mitral valve repair. A 23-mm endoreturn cannula was placed through a 10-mm graft that was sewn to the left axillary artery. An endoballoon was passed through the Dacron/cannula complex and into the ascending aorta. This complex was used for simultaneous antegrade perfusion, endoballoon occlusion, and antegrade cardioplegia. Completion transesophageal echocardiography showed no evidence of mitral regurgitation. The patient had an uneventful postoperative course and was doing well at his 2-month follow-up appointment. The left axillary artery is a viable option for simultaneous endoballoon occlusion, antegrade perfusion, and antegrade cardioplegia in robotic mitral valve surgery. This has the potential benefit of providing antegrade perfusion, which some studies have shown to be associated with a decreased risk of complications when compared with retrograde perfusion specifically in patients with severe peripheral vascular disease.
From the Departments of *Surgery and †Cardiac Surgery, Temple University School of Medicine, Philadelphia, PA USA.
Vishnu V
VV
Ambur
Sagar S
SS
Kadakia
Sharven
S
Taghavi
Senthil N
SN
Jayarajan
Mohammed Abul
MA
Kashem
James
J
McCarthy
Akira
A
Shiose
Grayson H
GH
Wheatley
Yoshiya
Y
Toyoda
T Sloane
TS
Guy
D000368:Aged; D001366:Axillary Artery / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods*; D003131:Combined Modality Therapy; D017548:Echocardiography, Transesophageal; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*; D010477:Perfusion / Q000379:methods; D065287:Robotic Surgical Procedures / Q000379:methods*