A simple method to establish antegrade cerebral perfusion during hemiarch reconstruction

Stephane Leung Wai Sang; Tyler J Beute; Tomasz Timek

doi:10.1016/j.xjtc.2020.03.012

A simple method to establish antegrade cerebral perfusion during hemiarch reconstruction

JTCVS Tech. 2020 Apr 9:2:10-15. doi: 10.1016/j.xjtc.2020.03.012. eCollection 2020 Jun.

Authors

Stephane Leung Wai Sang^{1

2}, Tyler J Beute², Tomasz Timek^{1

2}

Affiliations

¹ Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich.
² Michigan State University College of Human Medicine, Grand Rapids, Mich.

Abstract

Objective: We describe a novel and safe technique using a 12F-14F pediatric arterial cannula to establish unilateral, selective, antegrade cerebral perfusion (ACP) during open hemiarch reconstruction.

Methods: Between January 2015 and September 2018, 42 patients underwent elective aortic aneurysm repair requiring an open distal anastomosis and at least a hemiarch replacement via hypothermic circulatory arrest by 2 surgeons. All distal reconstructions were performed at moderate hypothermia (22°C-26°C) with direct cannulation of the innominate artery (IA) using a pediatric arterial cannula to allow ACP at 10-15 mL/kg/min. Data were collected by retrospective chart review.

Results: Thirty-one of the 42 patients (74%) were male. The mean patient age was 65 ± 13 years, and the mean body surface area was 2.1 ± 0.3 m². Proximal repairs included a modified Bentall with a valve-graft composite (n = 17), valve-sparing root replacement (n = 2), and aortic valve replacement (n = 15). Perioperative mortality was 2% (n = 1), and the incidence of stroke was 0%. The mean lowest core body temperature reached during circulatory arrest was 23.8 ± 2.7°C with a mean ACP time of 21.8 ± 3.6 minutes. The mean aortic cross-clamp and cardiopulmonary bypass times were 160.6 ± 55.5 minutes and 204.7 ± 57.5 minutes, respectively. There were no cases of IA injury.

Conclusions: Direct IA cannulation with a pediatric arterial cannula is a safe and efficient method to allow ACP in aortic surgery requiring hypothermic circulatory arrest and may circumvent the potential complications of axillary cannulation.

Keywords: ACP, antegrade cerebral perfusion; CPB, cardiopulmonary bypass; HCA, hypothermic circulatory arrest; IA, innominate artery; antegrade cerebral perfusion; aortic surgery; circulatory arrest; innominate artery.