Innominate artery cannulation for proximal aortic surgery: outcomes and neurological events in 263 patients

Abstract

Objectives: To determine whether innominate artery cannulation is the ideal perfusion strategy for delivering antegrade cerebral perfusion (ACP) during surgery on the proximal ascending aorta and transverse aortic arch.

Methods: A total of 263 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta. Operations performed were ascending and proximal arch replacement (n = 213, 81.0%), ascending and total arch replacement (n = 33, 12.6%) and ascending aortic replacement (n = 12, 4.6%). Concomitant or other procedures included aortic root replacement and repair (n = 113, 43.0%), aortic valve replacement or repair (n = 118, 44.9%), coronary artery bypass (n = 40, 15.2%), antegrade stent graft delivery to the proximal descending thoracic aorta for aneurysm or dissection (n = 28, 10.7%), mitral valve repair (n = 11, 4.2%), patent foramen ovale repair (n = 3, 1.1%) and tricuspid valve repair (n = 2, 0.8%). Twenty-seven patients (10.3%) presented with acute or subacute Type I aortic dissection, and 45 (17.1%) had a previous sternotomy. Median cardiopulmonary bypass (CPB), cardiac ischaemia and ACP times were 126.0 [95-163 interquartile range (IQR)], 91.0 (73-121 IQR) and 21.0 (16-32 IQR) min. Bilateral ACP was delivered in 235 patients (90.7%).

Results: The operative mortality rate was 4.9% (n = 13). Nine patients (3.4%) had postoperative stroke, which was permanent in 5 (1.9%) of them. Multivariate analysis associated risk of stroke or temporary neurological deficit with acute or subacute Type I aortic dissection (P = 0.028) and age (P = 0.015). Renal disease (P = 0.036) and CPB time (P = 0.011) were independent risk factors for operative mortality. Circulatory arrest time was identified as a risk factor for mortality (P = 0.038).

Conclusions: Innominate artery cannulation can be performed safely and poses a low risk of neurological events in procedures requiring hypothermic circulatory arrest. The technique for cannulating this artery should be part of the routine armamentarium of cardiac and aortic surgeons, and the innominate artery is among the preferred perfusion sites for delivering ACP.

Keywords: Aortic surgery; Axillary artery cannulation; Innominate artery cannulation.