Innominate Artery Graft Cannulation for Selective Antegrade Cerebral Perfusion in Aortic Surgery: Clinical Findings and Feasibility

Abstract

Background: Cerebral protection during aortic surgery is crucial for improving surgical outcomes and reducing neurological complications. Selective antegrade cerebral perfusion (SACP) is increasingly used, and innominate artery (IA) side graft cannulation presents an innovative alternative to conventional axillary artery cannulation, with the potential to reduce complications associated with the latter. Methods: In this retrospective study, 196 patients who underwent proximal aortic surgery with IA graft cannulation for SACP between January 2021 and June 2024 were analyzed. Demographic data, intraoperative parameters, and postoperative outcomes were evaluated. Complications such as new stroke, postoperative delirium, mortality, and acute renal failure (ARF) were assessed. Results: The median age of the patients was 63 years, and 18.37% underwent emergency surgery for Type A acute aortic dissection (TAAAD). The most frequently performed surgical procedure was ascending aorta and hemiarch replacement (36.74%). The median cardiopulmonary bypass, cross-clamp, and SACP durations were 120.5, 93, and 23 min, respectively. The postoperative mortality rate was 3.06%, stroke rate was 2.04%, delirium rate was 9.18%, and ARF rate was 3.06%. All cases of delirium resolved spontaneously within 2-3 days. The mortality rate among Marfan syndrome (MFS) patients was 4.35%, with no reported stroke cases in this group. Conclusions: IA graft cannulation is a safe and effective method for providing SACP in aortic surgery, particularly in high-risk patient groups such as those with TAAAD and MFS. This technique ensures optimal cerebral perfusion, minimizes neurological and systemic complications, and enhances surgical efficiency by reducing operative duration. However, large-scale, multicenter, and prospective studies are needed to evaluate its long-term efficacy and safety.

Keywords: Marfan syndrome; Type A acute aortic dissection; aortic surgery; cerebral protection; innominate artery cannulation; neurological complications; selective antegrade cerebral perfusion.

Figure 1

This flowchart illustrates the inclusion and exclusion criteria for patient selection in this study. Inclusion criteria are shown on the left in green, while exclusion criteria are displayed on the right in red. This structured selection process ensures a homogeneous study population, focusing on the safety and feasibility of IA cannulation in aortic surgery.

Figure 2

This image illustrates a 5 cm-long graft connected to a 3/8-inch connector, which is utilized for arterial cannulation in selective antegrade cerebral perfusion (SACP). The sterile surgical ruler displayed alongside the graft provides precise scaling for reference. The configuration demonstrates the compact and efficient design of the graft-connector assembly, emphasizing its practical application in achieving optimal blood flow during the procedure.

Figure 3

This image demonstrates an intraoperative view showing the successful anastomosis of a side graft to the innominate artery (IA). The graft is securely positioned within the surgical field, clearly illustrating its role in facilitating perfusion during the procedure.

Figure 4

This bar chart illustrates the distribution of surgical procedures performed in the study population. Ascending aorta and hemiarch replacement was the most frequently performed procedure (72 patients), followed by coronary bypass surgery (45 patients). Other procedures included Bentall procedures, valve replacements (AVR, MVR), and combined procedures. This distribution reflects the diverse nature of surgical interventions in patients undergoing aortic surgery with IA cannulation.