Selective antegrade cerebral perfusion via right axillary artery cannulation reduces morbidity and mortality after proximal aortic surgery

Abstract Background Direct cannulation of the innominate artery for selective antegrade cerebral perfusion has been shown to be safe in elective proximal aortic reconstructions. We sought to evaluate the safety of this technique in acute aortic dissection. Methods A multi-institutional retrospective review was undertaken of patients who underwent proximal aortic reconstruction for Stanford type A dissection between 2006 and 2016. Those patients who had direct innominate artery cannulation for selective antegrade cerebral perfusion were selected for analysis. Results Seventy-five patients underwent innominate artery cannulation for ACP for Stanford Type A Dissections. Isolated replacement of the ascending aorta was performed in 36 patients (48.0%), concomitant aortic root replacement was required in 35 patients (46.7%), of whom 7 had a valve-sparing aortic root replacement, ascending aorta and arch replacement was required in 4 patients (5%). Other procedures included frozen elephant trunk (n = 11 (14.7%)), coronary artery bypass grafting (n = 20 (26.7%)), and peripheral arterial bypass (n = 4 (5.3%)). Mean hypothermic circulatory arrest time was 19 ± 13 min. Thirty-day mortality was 14.7% (n = 11). Perioperative stroke occurred in 7 patients (9.3%). Conclusions This study is the first comprehensive review of direct innominate artery cannulation through median sternotomy for selective antegrade cerebral perfusion in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and cerebral protection for delivering selective antegrade cerebral perfusion in these cases.

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INNOMINATE ARTERY CANNULATION FOR PROXIMAL AORTIC SURGERY

10.22541/au.160898094.42392101/v1 ◽

2020 ◽

Author(s):

Bülent Mert ◽

kamil boyacıoğlu ◽

Hakan Sacli ◽

Berk Özkaynak ◽

Ibrahim Kara ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Aortic Surgery ◽

Innominate Artery ◽

Arterial Injury ◽

Ascending Aorta ◽

Artery Cannulation ◽

The Mean ◽

Antegrade Cerebral Perfusion

Background. The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side graft technique in proximal aortic pathologies. Methods. A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an avarage age of 56 ±13 years. The indications of surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%) and ascending aorta pseudoaneurysm in 1 patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). 3 patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta and hemiarch replacement in 34 patients (48.5%). Results. The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and164+56 minutes, respectively. The mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22’C and 30’C during surgery. 30-day mortality rate was 7.1% with 5 patients. 1 patient (1.4%) had stroke, 1 patient (1.4%) had temporary neurologic deficit and 8 patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury was encounterd. Conclusions. Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides excellent neurologic outcomes for proximal aortic surgery.

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Axillary versus innominate artery cannulation for antegrade cerebral perfusion in aortic surgery: design of the Aortic Surgery Cerebral Protection Evaluation (ACE) CardioLink-3 randomised trial

BMJ Open ◽

10.1136/bmjopen-2016-014491 ◽

2017 ◽

Vol 7 (6) ◽

pp. e014491 ◽

Cited By ~ 7

Author(s):

Vinay Garg ◽

Mark D Peterson ◽

Michael WA Chu ◽

Maral Ouzounian ◽

Roderick GG MacArthur ◽

...

Keyword(s):

Cerebral Perfusion ◽

Aortic Surgery ◽

Randomised Trial ◽

Innominate Artery ◽

Cerebral Protection ◽

Artery Cannulation ◽

Antegrade Cerebral Perfusion

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The Impact of Optimal Cerebral Perfusion Pressure on Postoperative Neurologic Outcome - A Propensity Score Analysis of 800 Patients with Selective Antegrade Cerebral Perfusion in Aortic Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0035-1544451 ◽

2015 ◽

Vol 63 (S 01) ◽

Author(s):

T. Siemeni ◽

A. Haverich ◽

Y. Li

Keyword(s):

Propensity Score ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Propensity Score Analysis ◽

Aortic Surgery ◽

Score Analysis ◽

Optimal Cerebral Perfusion Pressure ◽

The Impact ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

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Thoracic aortic surgery with moderate circulatory arrest and cold selective antegrade cerebral perfusion: A multivariate analysis in elective patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2008-1037849 ◽

2008 ◽

Vol 56 (S 1) ◽

Author(s):

C Hagl ◽

N Khaladj ◽

S Peterss ◽

M Shrestha ◽

I Kutschka ◽

...

Keyword(s):

Multivariate Analysis ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Aortic Surgery ◽

Thoracic Aortic Surgery ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion ◽

Elective Patients

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The Use of Innominate Artery Cannulation for Antegrade Cerebral Perfusion in Aortic Dissection

10.21203/rs.3.rs-18770/v2 ◽

2020 ◽

Author(s):

Eden C Payabyab ◽

Jonathan M. Hemli ◽

Allan Mattia ◽

Alex Kremers ◽

Sohrab K. Vatsia ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Cerebral Perfusion ◽

Innominate Artery ◽

Type A ◽

Ascending Aorta ◽

Aortic Root Replacement ◽

Artery Cannulation ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

Abstract Background: Direct cannulation of the innominate artery for selective antegrade cerebral perfusion has been shown to be safe in elective proximal aortic reconstructions. We sought to evaluate the safety of this technique in acute aortic dissection. Methods: A multi-institutional retrospective review was undertaken of patients who underwent proximal aortic reconstruction for Stanford type A dissection between 2006 and 2016. Those patients who had direct innominate artery cannulation for selective antegrade cerebral perfusion were selected for analysis. Results: Seventy-five patients underwent innominate artery cannulation for ACP for Stanford Type A Dissections. Isolated replacement of the ascending aorta was performed in 36 patients (48.0%), concomitant aortic root replacement was required in 35 patients (46.7%), of whom 7 had a valve-sparing aortic root replacement, ascending aorta and arch replacement was required in 4 patients (5%). Other procedures included frozen elephant trunk (n = 11 (14.7%)), coronary artery bypass grafting (n = 20 (26.7%)), and peripheral arterial bypass (n = 4 (5.3%)). Mean hypothermic circulatory arrest time was 19 ± 13 minutes. Thirty-day mortality was 14.7% (n = 11). Perioperative stroke occurred in 7 patients (9.3%).Conclusions: This study is the first comprehensive review of direct innominate artery cannulation through median sternotomy for selective antegrade cerebral perfusion in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and cerebral protection for delivering selective antegrade cerebral perfusion in these cases.

Download Full-text