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Cannulation of the innominate artery with a side graft in arch surgery
Fang Jiong Huang1, Qiang Wu, Chang Wei Ren
1Cardiac Surgery Division, Beijing Institute of Heart, Lung and Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China.
Insights
This study found that using a side graft for innominate artery cannulation during aortic arch surgery is safe and effective. This technique demonstrated good outcomes with low rates of complications and mortality in patients undergoing complex aortic procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Surgery
Background:
- Arch surgery often requires reliable arterial cannulation for cardiopulmonary bypass.
- The innominate artery is a potential cannulation site, but its use requires careful technique.
- Assessing the safety and efficacy of specific cannulation methods is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of cannulating the innominate artery using a side graft during aortic arch surgery.
- To determine the clinical outcomes associated with this specific arterial cannulation technique.
Main Methods:
- A cohort of 46 patients undergoing aortic arch surgery between 2004 and 2009 were studied.
- All patients received surgery under hypothermia circulatory arrest (HCA) and hemispheric antegrade cerebral perfusion (HACP).
- An 8-mm vascular graft was anastomosed in an end-to-side manner to the innominate artery for cannulation.
Main Results:
- The study reported a 10.9% rate of temporary postoperative neurologic dysfunction and no permanent neurologic deficits.
- The 30-day mortality rate was 6.5% (3 patients).
- Follow-up averaged 24.9 months, with no reported deaths or severe complications during this period.
Conclusions:
- Cannulation of the innominate artery with a side graft is a safe and effective method for arch surgery.
- This technique is associated with acceptable short-term and long-term outcomes in patients undergoing complex aortic procedures.
Background:
The purpose of this study was to examine the safety and efficacy of cannulation of the innominate artery with a side graft in arch surgery.
Methods:
Between January 2004 and March 2009, 46 patients received arch surgery under hypothermia circulatory arrest (HCA) and hemispheric antegrade cerebral perfusion (HACP). There were 36 men and 10 women with an average age of 48.0 +/- 12.8 years. Thirty-four patients had type A aortic dissection. Four patients had type B aortic dissection. The remaining 8 patients had aortic aneurysm involving the ascending aorta and arch. The innominate artery was free of diseases in all patients. The diameter of the innominate artery was 12.1 +/- 1.6 mm (range, 9 to 16 mm). An 8-mm vascular graft, which was anastomosed to the innominate artery in an end-to-side manner, was used for arterial cannulation. Ascending aorta and arch replacement in combination with open stent-graft implantation was conducted in 42 patients. Four patients received open stent-graft implantation through the aortic arch only.
Results:
The aortic cross-clamp time was 87.2 +/- 36.0 minutes. The lowest nasopharyngeal temperature was 21.0 +/- 3.6 degrees C. The HCA and the HACP time was 29.6 +/- 14.0 minutes. The HACP flow was 8.3 +/- 2.3 mL x kg(-1) x min(-1). Five patients (10.9%) had temporary postoperative neurologic dysfunction. There was no permanent neurologic dysfunction. Three patients died within 30 days postoperatively, and the 1-month mortality rate was 6.5%. All of the surviving patients were followed for 24.9 +/- 18.0 months (range, 1 to 63). There were no deaths or severe complications during the follow-up.
Conclusions:
Cannulation of the innominate artery with a side graft is safe and effective in arch surgery.