Innominate artery cannulation: an alternative to femoral or axillary cannulation for arterial inflow in proximal aortic surgery

J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S191-6. doi: 10.1016/j.jtcvs.2012.11.061. Epub 2012 Dec 20.

Abstract

Objective: To evaluate the effectiveness of innominate artery cannulation in proximal aortic procedures, including those involving hypothermic circulatory arrest.

Methods: A total of 68 patients underwent innominate artery cannulation with a side graft during proximal aortic surgery performed by way of a median sternotomy. The indications for surgery were proximal arch aneurysm in 43 patients (63.2%), aortic dissection in 11 patients (16.2%), total arch aneurysm in 10 patients (14.7%), and ascending aortic aneurysm in 4 patients (5.9%). Six patients (8.8%) had undergone previous sternotomy. Hypothermic circulatory arrest with antegrade cerebral perfusion was used in 64 patients (94.1%). Of the 68 patients, 63 (92.6%) received antegrade cerebral perfusion to both cerebral hemispheres. The median antegrade cerebral perfusion time was 20 minutes (range, 15.0-33.0 minutes). Seven patients had periods of circulatory arrest without antegrade cerebral perfusion for a median of 20 minutes (range, 6-33 minutes).

Results: One patient died, for 30-day mortality of 1.5%. Three patients (4.4%) had strokes, two of whom had a partial recovery. Seven patients (10.3%) developed temporary postoperative confusion that resolved successfully in all cases.

Conclusions: Cannulating the innominate artery for arterial inflow is an alternative technique for proximal aortic surgery procedures. It is especially useful in cases requiring hypothermic circulatory arrest to deliver antegrade cerebral perfusion.

MeSH terms

  • Aged
  • Aneurysm, Dissecting / mortality
  • Aneurysm, Dissecting / physiopathology
  • Aneurysm, Dissecting / surgery*
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / physiopathology
  • Aortic Aneurysm, Thoracic / surgery*
  • Axillary Artery*
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / mortality
  • Brachiocephalic Trunk*
  • Catheterization, Peripheral / adverse effects
  • Catheterization, Peripheral / methods*
  • Catheterization, Peripheral / mortality
  • Cerebrovascular Circulation
  • Confusion / etiology
  • Female
  • Femoral Artery*
  • Heart Arrest, Induced
  • Hospital Mortality
  • Humans
  • Hypothermia, Induced
  • Linear Models
  • Male
  • Middle Aged
  • Perfusion / adverse effects
  • Perfusion / methods*
  • Perfusion / mortality
  • Risk Factors
  • Sternotomy
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome