Axillary Dacron Graft Versus Direct Femoral Arterial Cannulation for Peripheral VA-ECMO After Heart Transplantation: A Single-Center Cohort Study

Background/Objectives: Primary graft dysfunction (PGD) remains a major cause of early morbidity and mortality after heart transplantation, and peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) represents an established rescue therapy for severe cases. Although direct femoral arterial cannulation is commonly used because of its rapid deployment, axillary artery cannulation through a Dacron graft provides antegrade arterial perfusion and may represent an alternative approach. This study compared early clinical outcomes and cannulation-related complications between these two arterial cannulation strategies.

Methods

In this retrospective single-center observational study, 42 consecutive adult heart transplant recipients requiring peripheral VA-ECMO for PGD were included. Patients were divided according to arterial cannulation strategy into direct femoral cannulation (DFC, n = 25) and axillary Dacron graft cannulation (ADG, n = 17). Baseline recipient and donor characteristics, perioperative variables, postoperative outcomes, vascular complications, successful VA-ECMO weaning, and survival to hospital discharge were compared. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for major clinical outcomes and cannulation-related complications.