Aortic and innominate cannulations are equally safe in redo aortic surgery

Chest reentry poses challenges for establishing cardiopulmonary bypass. This study aimed to compare postoperative neurologic outcomes between aortic (AC) and innominate cannulation (IC) in redo aortic surgery.

We retrospectively reviewed 201 patients undergoing redo sternotomy for aortic aneurysm repair from 2010 to 2024. Patients were stratified by cannulation site: AC (n = 119) or IC (n = 34); 48 patients who underwent other approaches were excluded. Demographics, intraoperative variables, and postoperative outcomes were compared. Propensity-score matching (PSM), logistic regression, and Kaplan-Meier analyses were performed.

Median age was 62.4 years; 75.8% were male. Before PSM, patients in the AC group had a lower smoking rate (38.7% vs 64.7%, P = .012) but a greater incidence of partial/total arch replacement (68.9% vs 23.5%, P < .001) compared with those in IC. IC was associated with lower nadir temperature (26.9 vs 27.5 °C, P = .044), longer crossclamp time (108.5 vs 87 minutes, P < .001), and more antegrade cerebral perfusion alone (91.2% vs 29.4%, P < .001). IC required more intraoperative fresh-frozen plasma (6 vs 4 units, P = .001). After PSM, crossclamp time did not differ, but IC had longer circulatory arrest (13 vs 9.4 minutes, P = .004) and lower end left cerebral oxygen saturation (67% vs 70%, P = .021). Postoperative stroke, encephalopathy/delirium, and mortality were similar. In multivariable regression analysis, cannulation site was not associated with postoperative stroke. Ten-year survival rates were 66.6% for AC and 65.0% for IC (P _log-rank = .551).

AC and IC are safe in redo sternotomy for aortic surgery, with similar neurologic and survival outcomes reported. Surgeons may choose either approach on the basis of preference and patient anatomy.