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. 2012 Nov 20:7:125.
doi: 10.1186/1749-8090-7-125.

How I do it--sole innominate cannulation for acute type A aortic dissection

Pankaj Kaul  1
Affiliations

How I do it--sole innominate cannulation for acute type A aortic dissection

Pankaj Kaul. J Cardiothorac Surg. .

Abstract

We describe sole direct innominate cannulation for arterial return for establishing both cardiopulmonary bypass and selective antegrade cerebral perfusion in the repair of acute type A dissection and compare it with femoral, axillary, direct aortic and apical cannulations. We believe innominate cannulation has all the advantages of right axillary cannulation and none of its disadvantages. It can be used in all patients in whom innominate artery is not dissected, obstructed, calcified or otherwise diseased.

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Figures

Figure 1
Figure 1
The left innominate vein (LIV), the innominate artery (IA), the left common carotid artery (LCCA) and the left subclavian artery (LSA) have been dissected and taped in a patient with type A dissection of aorta with a pre-existing aneurysm of aortic root and ascending aorta, before pericardium is opened.
Figure 2
Figure 2
A 20 F wire reinforced Medtronic cannula.
Figure 3
Figure 3
The innominate artery (IA) has been cannulated with 20 F Medtronic cannula which has been advanced into the arch.
Figure 4
Figure 4
Pericardium is opened in a patient with type A dissection of aorta and as feared the aorta has ruptured with hemopericardium, but innominate artery (IA) is ready for cannulation and establishment of cardiopulmonary bypass.
Figure 5
Figure 5
The dissected aorta is cross clamped midway between the sinotubular junction and innominate artery origin at a place which will be subsequently excised. This does not pressurise the false lumen owing to antegrade flow in the arch through the innominate cannula.
Figure 6
Figure 6
Long intimal tear in ascending aorta extending to just below the innominate artery. Whole of ascending aorta and whole of intimal tear must be excised in repair of type A dissection.
Figure 7
Figure 7
Retrograde dissection of ascending aorta from descending aortic intimal tear with pre-existing coronary artery disease. Repair included supra-coronary replacement of ascending aorta, suture repair of descending aortic tear and CABG X 3.
Figure 8
Figure 8
Open distal anastomosis with lower body circulatory arrest (LBCA) at 17 C and unihemispherical antegrade selective cerebral perfusion (ASCP) through the innominate cannula which has been redirected cranially. Decision for unihemispherical ASCP guided by adequate bilateral radial pressures, cerebral oxymetry and copious backflows from LCCA and LSA.
Figure 9
Figure 9
The completed dissection repair, the arch vessel tapes have been unsnugged and the innominate cannula redirected into the arch again.
Figure 10
Figure 10
Aortic root, ascending aorta and total arch replacement in a patient with aneurysmal disease using composite innominate cannulation.
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