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. Results: The primary composite endpoint of cannulation-related complications occurred in 0/17 patients (0%) in the ADG group and 3/25 patients (12.0%) in the DFC group (OR 0.18, 95% CI 0.01–3.80; p = 0.260). Successful VA-ECMO weaning was achieved in 94.1% versus 92.0% (p = 1.000), and survival to hospital discharge was 76.5% versus 64.0% (OR 1.83, 95% CI 0.46–7.32; p = 0.505). Stroke occurred in 5.9% versus 16.0% (OR 0.33, 95% CI 0.03–3.23; p = 0.632), while renal replacement therapy was required in 35.3% versus 52.0% (OR 0.50, 95% CI 0.14–1.79; p = 0.353). No statistically significant differences were detected between groups. Conclusions: No statistically significant differences in successful VA-ECMO weaning or survival to hospital discharge were observed between axillary Dacron graft and direct femoral arterial cannulation. No statistically significant differences in neurological, vascular, or other major postoperative outcomes were detected. Although several complications occurred numerically less frequently with axillary cannulation, the limited sample size and wide confidence intervals preclude conclusions regarding comparative superiority. Axillary Dacron graft cannulation may therefore represent a feasible alternative in selected heart transplant recipients requiring peripheral VA-ECMO for PGD. Larger prospective multicenter studies are warranted.