Aortoaxillary bypass during cardiac operation.

Aims: The aim of the present study was to analyze our experience in the use of the aortoaxillary bypass during cardiac operation in a limited series of patients with proximal atherosclerotic lesion of the subclavian artery combined with cardiac disease amenable to surgical treatment.

Methods: Of 1953 consecutive patients who underwent cardiac operation at our unit between April 2009 and July 2012, nine (0.5%; four women and five men; mean age 69.0 ± 6.2 years) suffered from symptomatic occlusive disease of the subclavian artery, and underwent concomitant aortoaxillary bypass. A ring-reinforced polytetrafluoroethylene vascular graft was anastomosed to the proximal segment of the axillary artery, introduced into the pleural cavity through the first or the second intercostal space, and anastomosed to the ascending aorta. All perioperative data were collected prospectively.

Results: Seven (77.8%) left and two (22.2%) right aortoaxillary bypasses were achieved. Ten concomitant cardiac operations were performed. There were no early postoperative complications related to the subclavian artery revascularization. At a mean follow-up of 27.3 ± 15.5 months, both the symptoms of the subclavian artery disease and those of the heart disease improved. High-resolution computed tomography angiography confirmed an excellent patency of the aortoaxillary bypass in all the patients but one.

Conclusion: Concomitant aortoaxillary bypass and cardiac operation may be an option to keep in mind for patients with coexisting subclavian artery occlusion and heart disease, after the evidence that the combined operation does not increase the risk. Attention should be paid to the course of the bypass graft toward the axillary artery.