Axillary artery cannulation techniques continue to improve and find application throughout cardiac surgery. Yet, early outcomes are poorly documented versus femoral or central arterial cannulation in right minithoracotomy mitral surgery.

There were 3,044 consecutive adult patients undergoing mitral valve surgery via right thoracotomy from 1996 to 2022 examined from a prospectively maintained database. Propensity score matching was used to compare outcomes of axillary versus aortic cannulation in 241 matched pairs and axillary versus femoral cannulation in 356 matched pairs.

Arterial cannulation was axillary (770 of 3,044; 25%) versus femoral (149 of 3,044; 5%) or central aortic (2,125 of 3,044; 70%). Axillary versus aortic or femoral patients were older (P < 0.001), more often redo (P < 0.001), more urgent (P < 0.001), and had more mitral replacement (P < 0.001) and tricuspid procedures (P < 0.001). After propensity score matching, cannulation groups did not differ in patient characteristics or concurrent surgical procedures. For matched patients, axillary artery cannulation was not independently associated with operative mortality (P = 0.3), postoperative respiratory failure (P = 0.3), perioperative stroke (P = 0.7), renal insufficiency (P = 0.4), pump time (P = 0.6), clamp time (P = 0.2), transfusion (P = 0.5), perioperative length of stay (P = 0.7), or survival (P = 0.6). Axillary cannulation increased operative time by 14 ± 7 min (P = 0.04) versus aortic or femoral artery cannulation.

Right axillary artery cannulation is a safe alternative for right minithoracotomy mitral surgery. Advantages may include avoidance of the aorta in reoperations or older patients, avoidance of peripheral atherosclerosis in older patients, and a low incidence of limb ischemia or wound infection. Disadvantages may include longer access time and an additional chest incision.