Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic Review and Meta- Analysis

Harky, Amer; Chan, Jeffrey Shi Kai; Bithas, Christiana; Hof, Alexander; Sharif, Monira; Froghi, Saied; Bashir, Mohamad

doi:10.21470/1678-9741-2018-0272

Cited by 10 publications

(8 citation statements)

References 22 publications

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“…The data showed no statistically significant difference in the in-hospital mortality rate at the cannulation site between RAA (6%) and IA (5.22%) ( P = 0.55). There were no significant differences between permanent and temporary nerve defects in RAA and IA cannulations [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Innominate artery direct cannulation provides brain protection during total arch replacement for acute type A aortic dissection

Kong

Ruan

et al. 2022

J Cardiothorac Surg

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Background This study aimed to investigate the safety of direct innominate arterial (IA) cannulation using a pediatric arterial cannula to establish selective antegrade cerebral perfusion (ACP) during total arch replacement (TAR) for acute Stanford type A aortic dissection (ATAAD). Methods This retrospective study included patients with ATAAD who underwent TAR with the frozen elephant trunk (FET) technique between October 2020 and November 2021. Patients treated with direct IA cannulation using a pediatric arterial cannula for selective anterograde cerebral perfusion were included in the study. Results Of the 29 patients, 24 (82.8%) were male. The average age was 50.9 ± 9.47 years. Proximal repair included aortic root plasty (27 patients, [93.1%]) and Bentall surgery (2 patients, [6.9%]). Perioperative mortality and stroke rates were 3.4% and 6.9%, respectively. The mean lowest core temperature was 23.8 ± 0.74 °C and the mean ACP time was 25 ± 6.4 min. The aortic cross-clamp and cardiopulmonary bypass times were 141 ± 28 and 202 ± 29 min, respectively. There were no cases of IA injuries. Conclusion Direct IA cannulation using a pediatric arterial cannula is a simple, safe, and effective technique for establishing ACP during TAR with the FET technique for ATAAD and can avoid the potential complications of axillary artery cannulation.

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Section: Discussionmentioning

confidence: 99%

Innominate artery direct cannulation provides brain protection during total arch replacement for acute type A aortic dissection

Kong

Ruan

et al. 2022

J Cardiothorac Surg

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“…The intraoperative procedure time supports the set-up showing similar operating time, but shorter CPB and crossclamp time for patients with axillary cannulation and open anastomosis. While in a metaanalysis of three studies prolonged CPB time during axillary perfusion has been found compared to cannulation of the innominate artery, other sources report no specific disadvantages in CPB time and axillary cannulation [ 19 , 26 ]. Our experience underlines that despite being techniqually more demanding axillary cannulation and additional hemiarch resection do not lead inevitably to longer operation and CPB times.…”

Section: Discussionmentioning

confidence: 99%

Freestyle aortic root prosthesis in combination with aortic replacement and open anastomosis: a retrospective analysis

Zientara

Rosselet-Droux

Bruijnen

et al. 2021

J Cardiothorac Surg

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Background The Freestyle® bioprosthesis is used for pathologies of the aortic root. Additional resection of the ascending aorta and the proximal arch in dissections or aneurysms might be indicated. The aim was to assess mid-term outcome regarding prosthetic performance, stroke, reoperations, and survival in various pathologies comparing patients with and without additional procedures on the ascending aorta and proximal arch focusing on the standardised technique of unilateral antegrade cerebral perfusion under moderate hypothermia. Methods Retrospective data analysis of 278 consecutive patients after Freestyle® root replacement between September 2007 and March 2017. Patients were divided in three categories due to the pathology of the aortic root (re-operation vs endocarditis vs dissection). Two groups based on the aortic anastomosis technique (open arch anastomosis (OA) versus non-open arch anastomosis (non-OA) were compared (119 OA vs 159 non-OA). Cardiovascular risk, previous cardiac events, intra- and postoperative data were evaluated. Inferential statistics were performed with Mann-Whitney U-test. Nominal and categorical variables were tested with Fisher-Freeman-Halton exact test. Kaplan-Meier estimate was used to assess survival. Results The follow-up rate was 90% (median follow-up: 39.5 months). There were differences in the indication (endocarditis: OA 5 (4.2%) vs non-OA 36 (24%), p < 0.0001; dissection: OA 13 (10.9%) vs non-OA 2 (1.3%); p = 0.0007). OA patients had less perioperative stroke (1 (1%) vs 15 (10%), p = 0.001) and shorter hospital stay (9 vs 12 days, p = 0.0004). There were no differences in the mortality (in-hospital: OA 8 (7%) vs non-OA 8 (5%); p = 0.6; death at follow-up: OA 5 (5%) vs non-OA 15 (11%); p = 0.1). Overall valve performance showed a well-functioning valve in 97.3% at follow-up. Conclusion The valve performance showed excellent results regardless of the initial indication. The incidence of stroke was lower in patients receiving an open arch anastomosis using unilateral antegrade cerebral perfusion without elevated mortality or prolonged hospital stay.

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“…Axillary inflow using a lateral graft reduces stroke and is a preferred method for complicated cardiac operations requiring circulatory arrest[ 57 ]. No superiority of AA cannulation over IA cannulation concerning perioperative outcomes in thoracic aortic surgery has been demonstrated[ 58 ]. In a study where they compared the early and late postoperative outcomes of patients who underwent axillary ( n = 107) and FA( n = 198) cannulation during the repair of acute Type A aortic dissection, Stamou et al [ 59 ] found that operative mortality was not affected by the cannulation site (16% for axillary cannulation vs 19% for femoral cannulation, P = 0.64) and that stroke rates were similar between the two techniques.…”

Section: Cannulation Strategiesmentioning

confidence: 99%

“…Blood transfusion rates were also found to be lower compared to the AA group[ 15 ]. Harky et al [ 58 ] reported shorter CPB times (173.12 ± 51.85 min for AA cannulation and 167.45 ± 54.67 min for IA cannulation, P = 0.004) in patients who underwent AA and IA cannulation. However, they did not find a significant difference between the two patient groups in terms of mean deep hypothermic circulatory arrest (DHCA) durations (29.14 ± 23.55 min for right AA cannulation and 38.48 ± 31.32 min for IA cannulation; P = 0.06).…”

Section: Cannulation Strategiesmentioning

confidence: 99%

Surgical strategies for severely atherosclerotic (porcelain) aorta during coronary artery bypass grafting

Şirin

2021

WJC

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Porcelain aorta (PA) is an asymptomatic atherosclerotic disease, characterized by circumferential calcification throughout the whole perimeter of the aorta. It is seen in 2% to 9.3% of patients undergoing elective coronary artery bypass grafting (CABG) and makes manipulation of the ascending aorta impossible. It has been clearly shown that most emboli seen and detected during the CABG procedure occur during aortic cross-clamping and aortic side-clamping. Manipulation of porcelain or a severely atherosclerotic aorta increases the risk of perioperative stroke. The incidence of stroke after CABG is between 0.48% and 2.9% , and the risk is correlated with the extent and severity of the atherosclerotic disease. A conventional CABG procedure involves successive steps that include cannulation of the ascending aorta, application of a cross-clamp to the aorta, and partial clamping of the aorta to create the proximal anastomosis. Therefore in procedures that involve cannulation, clamping, or proximal anastomosis, and where aortic manipulation is inevitable, preassessment of the atherosclerotic aortic plaques is crucial. Although many surgeons still rely on intraoperative manual aortic palpation, this approach has very low sensitivity and underestimates the severity of the atherosclerotic illness. Imaging methods including preoperative computed tomography or intraoperative epiaortic ultrasonography enable modification of the surgical technique according to the severity of atherosclerosis. Various surgical techniques have been described to reduce the risk of atheroembolism that may lead to cerebrovascular events in patients with severely atherosclerotic ascending aorta. Anaortic or “no-touch” techniques that do not utilize aortic manipulation may significantly decrease the development of neurological complications by avoiding aortic maneuvers known to cause emboli. In cases where severe atherosclerotic disease or other factors preclude safe use of the ascending aorta, modifications in the surgical techniques, such as switching to different cannulation sites including the axillary/subclavian, femoral and innominate arteries, or using hypothermic ventricular fibrillation and in-situ pedicled arterial grafts, or performing proximal anastomoses at alternative anatomical locations will enable CABG operations to be performed safely with low morbidity and mortality rates in patients with porcelain aortas.

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Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic Review and Meta- Analysis

Cited by 10 publications

References 22 publications

Innominate artery direct cannulation provides brain protection during total arch replacement for acute type A aortic dissection

Innominate artery direct cannulation provides brain protection during total arch replacement for acute type A aortic dissection

Freestyle aortic root prosthesis in combination with aortic replacement and open anastomosis: a retrospective analysis

Surgical strategies for severely atherosclerotic (porcelain) aorta during coronary artery bypass grafting

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