Direct Cannulation of the Innominate Artery as Safe Technique for Antegrade Cerebral Perfusion in Proximal Aortic Surgery

Vladislav V. Aminov, Dmitrii R. Tereschenko, Evgenii V. Ignatov, Mihail A. Svetkin, Dmitrii B. Bragin, Konstantin S. Chudinovskii

Federal Centre for cardiovascular surgery (Chelyabinsk), Chelyabinsk, Russia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective: To evaluate the safety of innominate artery direct cannulation in proximal aortic procedures, including hypothermic circulatory arrest.

Methods: From January 2012 to December 2016, 239 patients underwent proximal aortic surgery. The indications for surgery were acute dissection (7 patients; 2,9%), chronic dissection (21 patients; 8,7%), ascending aneurysm (151 patients; 63,1%), ascending and proximal arch aneurysm (36 patients; 15,0%) and total arch aneurysm (24 patients; 10,0%). All patients were divided into two groups:withthe first group – arch cannulation was used (198 patients; 82,5%) and with the second one – direct cannulation of the innominate artery was performed (42 patients; 17,5%). Hypothermic circulatory arrest with antegrade cerebral perfusion was used in 45 patients (18,8%).

Results: The hospital mortality in the first group was 2,5% (5/198) that was not stroke-related. And there was no mortality in the group with innominate artery cannulation(p=0,59). The mean cross-clamp time for the first and the second groups was 140,3 ± 32,3 min and 152,9 ± 30 min, respectively (p=0,781). The mean cardiopulmonary bypass time for the first and the second groups was 184,5 ± 49,1 min and 255,7±61 min, respectively (p=0,365). Thirteen patients (6,7%) from the first group had neurological complications: there were 7 permanent strokes (3,6%) and 6 (3,1%) temporary ischemic attacks which resolved successfully in all cases. Two patients (4,7%) from the second group had the same complications (p=0,474): one patient (2,4%) had a stroke and the other patient (2,4%) - temporary ischemic attack.

Conclusion: Direct cannulation of the innominate artery for arterial inflow is a safe technique for proximal aortic surgery procedures. It is especially useful in cases which require hypothermic circulatory arrest for delivering antegrade cerebral perfusion.