Reply to the Editor

Abstract

We thank Bozok and colleagues for their insightful comments on the technique of innominate artery cannulation during surgical repair of Stanford type A aortic dissection, as described in our recently published article.1Shi E. Gu T. Yu L. Xiu Z. Zhang Z. Wang C. et al.Repair of Stanford type A aortic dissection with ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique by using innominate cannulation.J Thorac Cardiovasc Surg. 2011; 142: 1458-1463Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Cannulation of the innominate artery directly2Ji S. Yang J. Ye X. Wang X. Brain protection by using innominate artery cannulation during aortic arch surgery.Ann Thorac Surg. 2008; 86: 1030-1032Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar or with a side graft3Huang F.J. Wu Q. Ren C.W. Lai Y.Q. Yang S. Rui Q.J. et al.Cannulation of the innominate artery with a side graft in arch surgery.Ann Thorac Surg. 2010; 89: 800-803Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar has been shown to be a simple and effective alternative in aortic arch surgery. In our series, 10 patients showed transient neurologic dysfunction, and in most cases this was simple confusion lasting less than 48 hours. No permanent neurologic dysfunction occurred. Transient neurologic dysfunction such as confusion is a frequent complication after cardiac surgery, especially among aged patients. We do not think that our results for brain protection are bad. During total body perfusion, the brain can be perfused through the left carotid artery as well as the right carotid artery. Therefore innominate artery cannulation is safe during surgical repair of Stanford A aortic dissection. We also agree, however, that pressure monitoring makes cerebral perfusion more accurate. The effect of innominate cannulation on cerebral perfusionThe Journal of Thoracic and Cardiovascular SurgeryVol. 144Issue 3PreviewWe congratulate Shi and colleagues1 on their study, “Repair of Stanford Type A Aortic Dissection With Ascending Aorta and Hemiarch Replacement Combined With Stent-Graft Elephant Trunk Technique by Using Innominate Cannulation.” In this study, the flow in the innominate artery during total body perfusion was toward the arcus aorta. During cerebral perfusion, the flow rate was 8 to 10 mL/(kg · min). Transient neurologic deficit occurred in 10 patients, which indicates that this situation is not a focal event but is related to perfusion defect. Full-Text PDF