Abstract
Several cannulation sites alternative to the ascending aorta, such as femoral, right axillary, carotid, innominate artery, and, less commonly, apical sites, have been proposed. Cannulation of the right subclavian artery, through sternotomy, is one possible means of establishing cardiopulmonary bypass, hence avoiding a second surgical incision. In our experience, cardiopulmonary bypass flow was adequate and circulatory arrest with antegrade cerebral perfusion was successfully performed in all cases. There was no in-hospital mortality.
Highlights
Techniques and ResultsWhen cannulation of the ascending aorta is not advisable, such as in cases of Type-A aortic dissection, alternatives including femoral, right axillary, carotid, and, less commonly, apex of the left ventricle have been proposed.1–4Cannulation of the femoral vessels carries risk of poor perfusion and retrograde thrombotic embolism.5 The cardiac apex can be very fragile
Nowadays the subclavian artery is our preferred site for cannulation when dissection involves the innominate artery, avoiding the complications of a second surgical incision
Dissection is still the bigger issue, but the subclavian artery usually is not involved in the dissection process, is generally more fragile than the femoral artery and cannulation can be traumatic
Summary
Techniques and ResultsWhen cannulation of the ascending aorta is not advisable, such as in cases of Type-A aortic dissection, alternatives including femoral, right axillary, carotid, and, less commonly, apex of the left ventricle have been proposed.1–4Cannulation of the femoral vessels carries risk of poor perfusion and retrograde thrombotic embolism.5 The cardiac apex can be very fragile. Keywords ► aortic dissection ► cannulation ► right subclavian artery cannulation Several cannulation sites alternative to the ascending aorta, such as femoral, right axillary, carotid, innominate artery, and, less commonly, apical sites, have been proposed. Cannulation of the right subclavian artery, through sternotomy, is one possible means of establishing cardiopulmonary bypass, avoiding a second surgical incision.
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