The use of innominate artery cannulation for antegrade cerebral perfusion in aortic dissection
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(2020) 15:205
RESEARCH ARTICLE
Open Access
The use of innominate artery cannulation for antegrade cerebral perfusion in aortic dissection Eden C. Payabyab1,2* , Jonathan M. Hemli3, Allan Mattia4, Alex Kremers1,5, Sohrab K. Vatsia3, S. Jacob Scheinerman3, Efstathia A. Mihelis3, Alan R. Hartman5 and Derek R. Brinster3
Abstract Background: Direct cannulation of the innominate artery for selective antegrade cerebral perfusion has been shown to be safe in elective proximal aortic reconstructions. We sought to evaluate the safety of this technique in acute aortic dissection. Methods: A multi-institutional retrospective review was undertaken of patients who underwent proximal aortic reconstruction for Stanford type A dissection between 2006 and 2016. Those patients who had direct innominate artery cannulation for selective antegrade cerebral perfusion were selected for analysis. Results: Seventy-five patients underwent innominate artery cannulation for ACP for Stanford Type A Dissections. Isolated replacement of the ascending aorta was performed in 36 patients (48.0%), concomitant aortic root replacement was required in 35 patients (46.7%), of whom 7 had a valve-sparing aortic root replacement, ascending aorta and arch replacement was required in 4 patients (5%). Other procedures included frozen elephant trunk (n = 11 (14.7%)), coronary artery bypass grafting (n = 20 (26.7%)), and peripheral arterial bypass (n = 4 (5.3%)). Mean hypothermic circulatory arrest time was 19 ± 13 min. Thirty-day mortality was 14.7% (n = 11). Perioperative stroke occurred in 7 patients (9.3%). Conclusions: This study is the first comprehensive review of direct innominate artery cannulation through median sternotomy for selective antegrade cerebral perfusion in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and cerebral protection for delivering selective antegrade cerebral perfusion in these cases. Keywords: Aortic dissection, Aortic arch, Direct innominate cannulation, Cerebral perfusion, Outcomes
* Correspondence: [email protected] Meeting Presentation: Presented at the American Association of Thoracic Surgery Aortic Symposium. New York, New York, April 2018 1 Division of Cardiac Surgery, Virginia Commonwealth University Health Systems, Richmond, VA, UK 2 Department of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a
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