Innominate artery cannulation in aortic surgery: A systematic review

Abstract

Objective: The innominate artery is considered an alternative site for establishing cardiopulmonary bypass in surgical procedures involving the thoracic aorta. This systematic review examines the use of innominate artery cannulation in aortic surgery.Methods: A systematic literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all studies that utilized innominate artery cannulation for establishing cardiopulmonary bypass and providing cerebral perfusion in thoracic aortic surgery. The data were reviewed up to September 2018.Results: Acute type A aortic dissection contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719) underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending and hemi-arch replacement, while 11.5% had total aortic arch replacement and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111). All-cause 30-day mortality rate was 2.7% (n = 61).Conclusion: Innominate artery cannulation is a safe technique in patients who undergo thoracic aortic surgery. It can be utilized, in selected cases, as a reliable route for establishing cardiopulmonary bypass and maintaining cerebral perfusion. K E Y W O R D S aorta, aortic surgery, cannulation, innominate artery

Proximal arterial cannulation in thoracic aortic surgery—Literature review

“…Direct cannulation is more time efficient as it does not require a graft anastomosis and thus prevents bleeding from suture lines; however, side graft cannulation reduces the complexity of the cannulation process by eliminating the need to reposition the tip of the cannula into the IA for providing ACP. Nevertheless, there is no evidence that either of these techniques reduces neurological complications, mortality, or morbidity rates, postoperatively …”

“…However, direct IA cannulation or through a side graft is increasingly used as an alternative to RAA for delivery of ACP during thoracic aortic surgery . This is due to the potential complications faced when using RAA cannulation such as the increased risk of brachial plexus injury, arm hyperperfusion, limb ischemia, and seromas . RAA cannulation also requires additional surgical dissections which increases operative time and can have a negative impact on the postoperative outcomes .…”

“…IA cannulation has been reported to be a safe and good approach in emergency cases provided that IA is not involved in the dissection process itself. 6,12 Rouchdy et al 16 that IA cannulation is associated technical issues in 1 to 4% of the cases; but the key concern was the cerebral ischemia that occurs transiently during IA cross-clamping. Garg et al 21 IA cannulation for elective complex aortic procedures with good postoperative outcomes including low stroke, delirium, and mortality rates.…”

“…22,26 These can be prevented by using the IA technique which possesses several advantages such as better monitoring of cerebral pressure via the right radial cannula. 6 A summary of the advantages and disadvantages of central cannulation techniques are outlined in Table 1.…”

“…12 IA should not be used in patients with atherosclerosis, calcification, dissection, or tortuosity of the IA. 6 Furthermore, IA may be avoided in total aortic arch replacement to allow full mobility of IA during separate head vessel reconstruction. 22 Similarly, RAA should be avoided in patients with problems to the axillary artery itself.…”