Left ventricular assist device implantation with axillary–axillary outflow graft

Contemporary utilization of the axillary artery in cardiac surgery

“…The axillary artery has been described as an alternative site for placement of the outflow graft of LVAD in the setting of a heavily calcified ascending aorta or hostile chest 39–41 . Nonsternotomy approaches, generally via left thoracotomy, to LVAD implantation may be employed with potential benefits.…”

“…The axillary artery has been described as an alternative site for placement of the outflow graft of LVAD in the setting of a heavily calcified ascending aorta or hostile chest. [39][40][41] Nonsternotomy approaches, generally via left thoracotomy, to LVAD implantation may be employed with potential benefits. The outflow graft is anastomosed to an 8 mm Goretex Hemashield graft and tunneled through the second intercostal space to the axillary artery in bridge-to-transplant patients, avoiding a median sternotomy for the future transplant operation.…”

Commentary: Sometimes there is a simpler route!

“…In this issue of the Journal , Tucker and colleagues 9 report the results of LVAD implantation with a novel alternative approach, the left axillary–right axillary arterial bypass (LARAAB) graft. In a minimally invasive setting, LARAAB was performed in a patient with a history of ischemic cardiomyopathy who underwent LVAD implantation for cardiogenic shock.…”

Commentary: Fashioning a replacement

“…These options include the supraceliac aorta, innominate artery, and the left axillary artery. 1 Tucker and colleagues 2 report the novel use of an extra-anatomic bypass to augment left ventricular assist device flow. 2 They fashioned an augmentation graft to improve axillary artery outflow with the use of a left axillary to right axillary arterial bypass graft.…”