M. Eldeiry1, M. Aftab1, K. Yamanaka1, M. S. Mosca1, C. Ghincea1, J. C. Cleveland1, D. Fullerton1, T. B. Reece1 1University Of Colorado Denver,Cardiothoracic Surgery,Aurora, CO, USA
Introduction:
Innominate artery cannulation has gained some popularity over the last decade as an alternative to axillary artery cannulation for providing antegrade cerebral perfusion (ACP) during repair of the ascending aorta and arch. Innominate artery cannulation provides several advantages including avoidance of an additional incision and use of a larger caliber artery to provide ACP. We hypothesize that these advantages make innominate artery cannulation superior to axillary artery cannulation as it can decrease operative times and potentially decrease blood loss.
Methods:
This was a single center retrospective analysis of 177 patients who underwent hemiarch replacement between 2009 and 2016. All patients qualified including emergent cases. Groups were separated by mode of cannulation: axillary vs innominate. Outcomes evaluated included cardiopulmonary bypass (CPB) time, cross-clamp (XC) time, circulatory arrest (CA) time, post-operative transfusions, intensive care unit length of stay, development of any neurological complications, end organ failure, and mortality. Sub-group analysis was performed for elective and emergent cases.
Results:
Axillary and innominate artery cannulation accounted for 42.4% (n=75) and 57.6% (n=102) of cases, respectively. There was no difference in patient characteristics except for a higher incidence of lung disease in the axillary group (21% vs. 9%, p=0.029). More emergent cases were performed in the axillary group (60% vs. 18%, p<0.001).
Operative times are summarized in Figure 1. Innominate cases had shorter CPB and CA times. In the elective subgroup, CA times were shorter for the innominate cases. However, the emergent subgroup displayed no difference.
Less transfusions were given in the innominate group including RBC (2[0,14] vs. 0[0,8], p<0.001), PLT (2[0,7] vs. 2[0,4], p=0.030) and FFP (6[0,20] vs. 3[0,11], p<0.001). A similar trend was observed for RBC and FFP in the elective subgroup. No difference was observed in the emergent subgroup.
There was no statistical difference in remaining outcomes between cases of axillary and innominate cannulation in the combined, elective, and emergent groups.
Conclusions:
Alternate cannulation strategies for open arch anastomoses are evolving with a trend towards utilizing the innominate artery. These data suggest that innominate cannulation is at least equivalent to, and may be superior to, axillary cannulation. The innominate artery provides a larger conduit vessel for perfusion and this decrease in resistance to flow, allowing for faster cooling and rewarming, maybe why CPB times were lower in this group. Innominate cannulation is a safe and potentially advantageous technique for hemiarch repair.
