A randomized trial comparing axillary versus innominate artery cannulation for aortic arch surgery

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Radiology

Background:

• Cerebral protection is critical for successful aortic surgery, but optimal strategies are debated.
• Antegrade cerebral protection aims to minimize neurological injury during these procedures.

Purpose of the Study:

• To compare the safety and efficacy of innominate versus axillary artery cannulation for antegrade cerebral protection.
• To evaluate neuroprotection and operative times in patients undergoing proximal aortic arch surgery.

Main Methods:

• A randomized controlled trial (CardioLink-3 Trial) involving 111 patients across 6 Canadian centers.
• Patients were allocated to either innominate or axillary artery cannulation.
• Primary outcomes included neuroprotection (assessed by diffusion-weighted MRI) and operative time; secondary outcomes included stroke and mortality.

Main Results:

• New severe ischemic lesions on MRI were observed in 38.8% of the axillary group versus 34% of the innominate group (non-inferiority P=.0009).
• Total operative times were comparable between the axillary (median 293 min) and innominate (median 298 min) groups (P=.47).
• Postoperative stroke/TIA occurred in 7.1% of the axillary group versus 3.6% of the innominate group (P=.43), with similar 30-day mortality and other secondary outcomes.

Conclusions:

• Antegrade cerebral protection using innominate artery cannulation is a safe alternative to axillary artery cannulation during aortic surgery.
• Both cannulation strategies provide similar levels of neuroprotection, as evidenced by diffusion-weighted MRI.
• A significant burden of new neurological lesions exists with both approaches, highlighting the need for further research into improved neuroprotective strategies.