To demonstrate a novel, reproducible, and effective method of direct innominate artery cannulation using a 14F pediatric venous cannula to establish antegrade cerebral protection (ACP) in patients undergoing aortic surgery that requires an open distal anastomosis or hemiarch replacement.
Methods
We reviewed prospectively gathered data on all patients who had undergone replacement of the ascending aorta or hemiarch with an open distal anastomosis using deep hypothermic circulatory arrest and direct innominate artery cannulation with a 14F pediatric venous cannula at our institution. After central cannulation and cooling to 25°C to 28°C, all patients had ACP initiated by way of a direct innominate cannula placed over a guidewire.
Results
Fifty patients underwent direct innominate artery cannulation with our technique from 2010 to 2012. The operative mortality was 2% (n = 1), and the rates of neurologic morbidity were acceptable and similar to those with other methods of ACP delivery: stroke (2%, n = 1), seizure (0%, n = 0), and delirium (18%, n = 9). The mean operative time was 31 ± 9, 19 ± 5, 100 ± 39, 141 ± 39, and 259 ± 63 minutes for cooling, circulatory arrest, crossclamp, cardiopulmonary bypass, and total operative time, respectively. No local or arterial complications were observed.
Conclusions
Direct cannulation of the innominate artery using a 14F pediatric venous cannula is a simple, reproducible, safe, and effective technique for establishing ACP in patients undergoing aortic surgery that requires an open distal anastomosis or hemiarch replacement. This technique avoids the additional time and potential local complications associated with other established methods for delivering ACP, such as axillary cannulation.
CTSNet classification
19
26.1
26.2
Abbreviations and Acronyms
ACP
antegrade cerebral perfusion
CPB
cardiopulmonary bypass
DHCA
deep hypothermic circulatory arrest
ICU
intensive care unit
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Disclosures: Authors have nothing to disclose with regard to commercial support.