Innominate artery cannulation for proximal aortic surgery

Introduction: Various cannulation techniques have been used for proximal aortic surgery, but which cannulation site is best remains controversial. Central and peripheral cannulation strategies and their brain-protective effects are currently being studied. Innominate artery cannulation, which allows cannulation and, if necessary, antegrade cerebral perfusion, has gained popularity in recent years. In our study, the advantages and disadvantages of innominate artery cannulation in proximal aortic surgery were examined and its effects on mortality and morbidity in the postoperative period were evaluated. Materials and Methods: Between 2018 and 2023, 199 patients who underwent elective and emergent surgery due to proximal aortic diseases at Pamukkale University Hospital were recorded. Patients who underwent aortic valve surgery, hemiarchus replacement and total arch replacement simultaneously during the operation were also included in the study. Mitral and tricuspid valve replacements, coronary bypass and different additional cardiac procedures were excluded from the study. In this period, innominate artery cannulation was used in 23 of 199 patients who were operated in accordance with the above conditions. Age and gender of all patients and whether they had a history of hypertension, diabetes mellitus, chronic obstructive pulmonary disease, coronary artery disease or previous cardiac surgery were recorded. The type of procedures performed during the operation (elective or emergency) were recorded. Cardiopulmonary bypass times (CPB), cross-clamp times, total circulatory arrest times (TCA) and perfusion types were recorded. Mechanical and biological valve use was noted in patients who underwent aortic valve replacement. Preoperative hemoglobin, hematocrit, platelet, creatine and urea values, as well as postoperative day 1 and postoperative day 7 values were recorded. Mortality and morbidity in all patients were evaluated. Postoperative length of stay in the intensive care unit and ward; postoperative neurological events, hemodialysis, revision and mortality and the amounts of blood product replacement given to the patients were recorded. Results: Innominate artery cannulation was compared as Group 1 (23 Patients), and other cannulations were compared as Group 2 (176 Patients). Between Group 1 and Group 2; in hospital mortality rate was 13% vs 18.8% (p:0.773), revision rate was 17.4% vs 13.1% (p:0.526), need for dialysis was 17.4% vs 14.2% (p:0.752) and rate of neurological events was 17.4% vs 16.5% (p:0.526). The amount of ES replacement given to patients was 3.95 ± 3.21 units in Group 1 and 3.04 ± 2.55 units in Group 2 (p:0.176). All blood and blood product replacements were found to be 7.56 ± 6.33 units in Group 1 and 5.65 ± 5.11 units in Group 2 (p:0.51). Mean CPB duration was 154.2 ± 31.6 minutes in Group 1, 163.5 ± 71 minutes in Group 2 (p:0.760). Mean cross clamp time was 105.4 ± 30.2 minutes in Group 1, 111.7 ± 51.9 minutes in Group 2 (p:0.646). Mean TCA time was 26.6 ± 8.5 minutes in Group 1 and 28.4 ± 10.5 minutes in Group 2 (p:0.741). Postoperative intensive care stay was 3.13 ± 1.84 days in Group 1, 3.07 ± 3.66 days in Group 2 (p:0.167). Postoperative ward stay was 6.69 ± 3.59 days in Group 1 and 6.20 ± 4.85 days in Group 2 (p:0.429). In 1 patient who underwent axillary cannulation, graft interposition was performed because the artery was dissected. In 2 patients, discharge developed at the wound site during hospitalization. In 1 patient, the stump graft piece left inside had to be excised and removed due to serous discharge in the wound area 3 months postoperatively. No graft infection or wound healing problems were observed in any patient who underwent innominate artery cannulation. When innominate artery cannulation (n = 23) and axillary artery cannulation (n = 97) were compared among themselves, in hospital mortality rate was 13% vs 20% (p:0.560), revision rate was 17.4% vs 12.4% (p:0.506), need for dialysis was 17.4% vs 14.4% (p:0.748) and rate of neurological events was 17.4% vs 20.6% (p:0.728). When innominate artery cannulation (n = 23) and femoral artery cannulation (n = 13) were compared among themselves, in hospital mortality rate was 13% vs 46% (p:0.045), revision rate was 17.4% vs 38.5% (p:0.235), need for dialysis was 17.4% vs 23.1% (p:0.686) and rate of neurological events was 17.4% vs 23.1% (p:0.686). Mortality was found to be significantly lower in innominate artery cannulation than in femoral artery cannulation. Conclusion: As a result of the study, it was shown that the innominate artery cannulation technique is safe, does not result in artery injury or dissection, and can be applied with an equal or less risk of mortality and neurological complications than other cannulation techniques.