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. 2020 Apr 9:2:10-15.
doi: 10.1016/j.xjtc.2020.03.012. eCollection 2020 Jun.

A simple method to establish antegrade cerebral perfusion during hemiarch reconstruction

Stephane Leung Wai Sang  1   2 , Tyler J Beute  2 , Tomasz Timek  1   2
Affiliations

A simple method to establish antegrade cerebral perfusion during hemiarch reconstruction

Stephane Leung Wai Sang et al. JTCVS Tech. .

Abstract

Objective: We describe a novel and safe technique using a 12F-14F pediatric arterial cannula to establish unilateral, selective, antegrade cerebral perfusion (ACP) during open hemiarch reconstruction.

Methods: Between January 2015 and September 2018, 42 patients underwent elective aortic aneurysm repair requiring an open distal anastomosis and at least a hemiarch replacement via hypothermic circulatory arrest by 2 surgeons. All distal reconstructions were performed at moderate hypothermia (22°C-26°C) with direct cannulation of the innominate artery (IA) using a pediatric arterial cannula to allow ACP at 10-15 mL/kg/min. Data were collected by retrospective chart review.

Results: Thirty-one of the 42 patients (74%) were male. The mean patient age was 65 ± 13 years, and the mean body surface area was 2.1 ± 0.3 m2. Proximal repairs included a modified Bentall with a valve-graft composite (n = 17), valve-sparing root replacement (n = 2), and aortic valve replacement (n = 15). Perioperative mortality was 2% (n = 1), and the incidence of stroke was 0%. The mean lowest core body temperature reached during circulatory arrest was 23.8 ± 2.7°C with a mean ACP time of 21.8 ± 3.6 minutes. The mean aortic cross-clamp and cardiopulmonary bypass times were 160.6 ± 55.5 minutes and 204.7 ± 57.5 minutes, respectively. There were no cases of IA injury.

Conclusions: Direct IA cannulation with a pediatric arterial cannula is a safe and efficient method to allow ACP in aortic surgery requiring hypothermic circulatory arrest and may circumvent the potential complications of axillary cannulation.

Keywords: ACP, antegrade cerebral perfusion; CPB, cardiopulmonary bypass; HCA, hypothermic circulatory arrest; IA, innominate artery; antegrade cerebral perfusion; aortic surgery; circulatory arrest; innominate artery.

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Figures

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Graphical abstract
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Intraoperative view of innominate artery and central aortic cannulation.
Figure 1
Figure 1
Intraoperative view of the innominate artery (IA) and central cannulation with schematic diagram of the bypass circuit during antegrade cerebral perfusion (ACP). A, The aortic aneurysm is cannulated in standard fashion while the IA is cannulated with a 12F or 14F pediatric cannula. B, Schematic diagram of ACP with the main arterial line spliced to the central aortic cannula via a 3/8-inch line and to the pediatric cannula via a 1/4-inch line with cross-clamping of the base of the IA.
Figure 2
Figure 2
A 14F pediatric arterial cannula.
Video 1
Video 1
Operative technique for innominate artery cannulation and the conduct of hypothermic circulatory arrest with antegrade cerebral perfusion. Video available at: https://www.jtcvs.org/article/S2666-2507(20)30160-7/fulltext.
See this image and copyright information in PMC

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