Innominate Artery Cannulation Research Articles

Innominate artery cannulation for congenital heart disease

Arterial cannulation of the ascending aorta is the standard for congenital heart surgery. However, in some situations ascending aortic cannulation can be difficult, and cannulation of the innominate artery may be preferable. These situations may include: operations on the ascending aorta, a small ascending aorta which may be obstructed by the arterial perfusion cannula, redo operations where vascular structures including the ascending aorta are adherent to the back of the sternum, and neoaortic calcification in a patient who has undergone a previous Norwood operation. Innominate artery cannulation also permits the use of low flow cerebral perfusion, with avoidance of total circulatory arrest. In neonates and infants, the femoral and axillary arteries are generally too small to permit adequate flows on cardiopulmonary bypass. We describe four cases as examples of operations in which we have found innominate artery cannulation to be advantageous.

EComment: Re: Innominate artery cannulation for congenital heart disease

eComment: Re: Innominate artery cannulation for congenital heart disease

Brain Protection by Using Innominate Artery Cannulation During Aortic Arch Surgery

The innominate artery cannulation (IAC) through the same sternotomy incision was used for 68 patients with aneurysm, involving the ascending aorta or the aorta arch. The IAC can get adequate flows during cooling and re-warming of cardiopulmonary bypass. It can also provide sufficient antegrade perfusion for brain during hypothermia circulation arrest. There is no relative complication noted for the technique, and we believe it is a simple and effective alternative.

Innominate artery cannulation

Innominate artery cannulation is indicated mainly for surgery which involves aortic root and aortic arch when pathology precludes standard cannulation of the ascending aorta. Thus, it can be used as the procedure of choice in cases of ascending aortic aneurysm, type A aortic dissection, porcelain aorta and reoperation for coronary or aortic surgery. It is performed through a standard median sternotomy, hence avoiding the complications of a second incision. It provides antegrade systemic and cerebral flow that is associated with improved distal organ perfusion and reduced rate of retrograde cerebral embolization compared to femoral arterial cannulation, Moreover, it eliminates potential complications from axillary artery cannulation, such as dissection, upper extremity malperfusion and brachial plexus injury. It is contraindicated in cases of excessive calcification and acute dissection clearly involving the innominate artery.

Safe Innominate Artery Cannulation for Cardiopulmonary Bypass in Neonates

To reduce the neurological complications of deep hypothermic circulatory arrest, continuous cerebral perfusion was introduced, either by direct innominate artery cannulation or by a tubular prosthesis. This second option, used in our clinical experience, has been extended to applications other than aortic arch reconstruction, to facilitate cardiopulmonary bypass in small neonates (< 3.0 kg) with complex congenital heart defects, and to facilitate postoperative extracorporeal membrane oxygenation.

Innominate Artery Cannulation for Aortic Surgery

When disease involving the ascending aorta or aortic arch precludes ascending aortic cannulation, axillary artery cannulation is used for cardiopulmonary bypass. An additional incision and the relatively small caliber of the axillary artery are the drawbacks of this approach. Innominate artery cannulation using the same sternotomy wound is a simple and effective alternative.

Direct Innominate Artery Cannulation in Acute Type A Dissection and Severe Thoracic Aortic Atheroma

ACUTE TYPE A aortic dissection is a surgical emergency.1 Integrated perioperative management is associated with improved clinical outcome, despite aortic arch repair with deep hypothermic circulatory arrest (DHCA).2,3 Femoral arterial cannulation is safe for all phases of operative repair (before aortic arch repair; after aortic arch repair), with a 2.5% incidence of malperfusion events.4 Although the femoral artery is the authors’ standard site for arterial cannulation in this setting, a case of acute type A dissection in a severely atheromatous aorta is reported that prompted a search for an alternative arterial cannulation site because of concerns about cerebral atheroembolization.

A new cannula for innominate artery cannulation

urgical treatment of Stanford type A aortic dissectionremains a difficult challenge. Among of the first prob-lems that the surgeon faces are the site and the type ofarterial cannulation, which are of paramount importancein having a good arterial flow, ensuring a good body perfusionwithout damaging organs, not extending the dissection, speedingup surgical correction, and ensuring antegrade post-correctionflow.We developed a modified right-angled cannula that allowscannulation of the innominate artery (IA) and uniform perfusionthroughout the procedure.

Cerebral malperfusion in acute type A dissection: Direct innominate artery cannulation

Cerebral malperfusion in acute type A dissection: Direct innominate artery cannulation