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Eur J Cardiothorac Surg 2007;32:270-273. doi:10.1016/j.ejcts.2007.03.050
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Cannulation of the innominate artery during surgery of the thoracic aorta: our experience in 55 patients

Department of Cardiovascular Surgery, Santa Maria Hospital, Bari, Italy

Received 29 January 2007; received in revised form 22 March 2007; accepted 26 March 2007.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, Santa Maria Hospital, Via de Ferrariis 18/D, 70124 Bari, Italy. Tel.: +39 080 5040190(O)/335 8168588(R); fax: +39 080 5040190. (Email: m_dieus{at}hotmail.com).

Background: Alternative cannulation sites such as the right/left axillary artery, the ascending aorta and aortic arch have been recently preferred to the femoral artery to improve neurologic outcome in patients undergoing surgery of the thoracic aorta. In 2004, we started to select the innominate artery as an arterial cannulation site for CPB and antegrade cerebral perfusion institution. Here we present our preliminary experience with 55 patients. Methods: Between November 2004 and 2006, 55 patients (mean age 60 ± 14 years) underwent surgery on the thoracic aorta using the innominate artery as a site for arterial cannulation. Indication for surgery was a degenerative aneurysm in 49 (89.1%), an acute type A dissection in 2 patients (3.6%), a post-dissection aneurysm in 3 (5.4%), a supravalvular aortic stenosis in 1 patient (1.8%). Operative procedure included total arch replacement (n = 9), hemiarch replacement (n = 6), ascending aorta replacement (n = 21), Bentall procedure (n = 18) and aortoplasty with patch (n = 1). Mean CPB and cross clamp times were 131 ± 60 and 95 ± 29 min, respectively. Mean cerebral perfusion time was 54 ± 26 min. Results: The hospital mortality rate was 3.6%. There were no permanent neurologic dysfunction and one (1.8%) temporary neurological dysfunction. Conclusion: Our results with the cannulation of the innominate artery were encouraging. This provides the same advantages of the axillary artery cannulation with greater simplicity and avoiding extra surgical incisions which may be site for local complications. It may represent a valid option for CPB and antegrade cerebral perfusion institution in aortic procedures.

Key Words: Aortic surgery • Cerebral protection