Does the arterial cannulation site for circulatory arrest influence stroke risk?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Hypothermic circulatory arrest (HCA) is used in complex adult cardiac surgeries.
• Stroke is a significant complication associated with HCA.
• The choice of arterial inflow cannulation site may influence stroke risk.

Purpose of the Study:

• To investigate if axillary/subclavian artery inflow with a side graft reduces stroke risk compared to other cannulation sites during HCA.
• To identify risk factors for stroke and hospital mortality in patients undergoing HCA.

Main Methods:

• A retrospective analysis of 1,352 complex adult cardiac operations involving HCA between 1993 and 2003.
• Comparative analysis of stroke and mortality rates based on arterial inflow cannulation sites (axillary plus graft, direct aortic, femoral, innominate, axillary/subclavian without graft).
• Propensity matching and multivariable logistic regression were used to identify risk factors.

Main Results:

• Stroke occurred in 6.1% of patients; the axillary plus graft group had a lower stroke rate (4.0%) compared to direct aortic cannulation (6.7%, p=0.05 in propensity-matched pairs).
• Direct aortic cannulation, aortic arteriosclerosis, descending aorta repair, and mitral valve replacement were associated with increased stroke risk.
• Femoral cannulation was associated with a higher hospital mortality rate (11%) compared to axillary plus graft (7.0%, p=0.02 in propensity-matched pairs).

Conclusions:

• Axillary artery inflow with a side graft is associated with reduced stroke risk and mortality in complex cardiac surgeries requiring HCA.
• This approach is recommended as the preferred method for such procedures.
• The use of retrograde or antegrade brain perfusion is determined selectively.