scholarly journals The use of innominate artery cannulation for antegrade cerebral perfusion in aortic dissection

2020 ◽  
Vol 15 (1) ◽  
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 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.

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

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.

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

2020 ◽  
Author(s):  
Eden C Payabyab ◽  
Jonathan M. Hemli ◽  
Allan Mattia ◽  
Alex Kremers ◽  
Sohrab K. Vatsia ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Median Sternotomy ◽  
Innominate Artery ◽  
Type A ◽  
Aortic Root Replacement ◽  
Artery Cannulation ◽  
Antegrade Cerebral Perfusion

Abstract Background Direct cannulation of the innominate artery for selective antegrade cerebral perfusion (SACP) 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 SACP 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. 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 ± 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 SACP in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and ACP for delivering selective ACP in these cases.

scholarly journals INNOMINATE ARTERY CANNULATION FOR PROXIMAL AORTIC SURGERY

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.

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

2021 ◽  
Vol 104 (4) ◽  
pp. 604-609
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Ultrasound Guided ◽  
True Lumen ◽  
Artery Cannulation ◽  
Aortic Cannulation ◽  
Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p<0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

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