Direct cannulation of arch vessels for total arch replacement

Abstract

Objectives: To observe the efficiency and safety of direct and indirect three arch vessels’ cannulation for bilateral antegrade cerebral perfusion during total arch replacement. Methods: Between 2002 and 2014, 130 patients underwent total arch replacement with direct and 66 patients with indirect cannulation for antegrade cerebral perfusion under moderate hypothermia. Patients were assigned to the direct cannulation group based on the condition of the aortic arch vessels. Demographics and concomitant surgeries were similar in the two groups. Patient characteristics, surgical and haemodynamic measurements, and postoperative neurologic findings were observed. Results: Aortic cross-clamping (120 ± 42 vs 139 ± 65 min; p = 0.032) and cardiopulmonary bypass (178 ± 57 vs 206 ± 71 min; p = 0.025) times were lower in the direct cannulation group. There were no differences in overall hospital mortality (4% vs 6%; p = 0.87), selective antegrade cerebral perfusion time (91 ± 52 vs 100 ± 65 min; p = 0.185), and incidence of neurologic deficit (3% vs 9%; p = 0.07). Indirect cannulation led to more frequent re-exploration for bleeding (5% vs 13%; p = 0.0356). There was no difference in midterm survival (log-rank p = 0.103; mean follow-up times: 4.74 years (direct cannulation), 5.50 years (indirect cannulation)). Conclusion: Direct cannulation during mild systemic hypothermia yields excellent outcomes while reducing time and rate of reoperation for bleeding and can be used in total arch replacement without increasing morbidity and mortality.