Cannulation of the innominate artery with a side graft in arch surgery.
BACKGROUND
The purpose of this study was to examine the safety and efficacy of cannulation of the innominate artery with a side graft in arch surgery.


METHODS
Between January 2004 and March 2009, 46 patients received arch surgery under hypothermia circulatory arrest (HCA) and hemispheric antegrade cerebral perfusion (HACP). There were 36 men and 10 women with an average age of 48.0 +/- 12.8 years. Thirty-four patients had type A aortic dissection. Four patients had type B aortic dissection. The remaining 8 patients had aortic aneurysm involving the ascending aorta and arch. The innominate artery was free of diseases in all patients. The diameter of the innominate artery was 12.1 +/- 1.6 mm (range, 9 to 16 mm). An 8-mm vascular graft, which was anastomosed to the innominate artery in an end-to-side manner, was used for arterial cannulation. Ascending aorta and arch replacement in combination with open stent-graft implantation was conducted in 42 patients. Four patients received open stent-graft implantation through the aortic arch only.


RESULTS
The aortic cross-clamp time was 87.2 +/- 36.0 minutes. The lowest nasopharyngeal temperature was 21.0 +/- 3.6 degrees C. The HCA and the HACP time was 29.6 +/- 14.0 minutes. The HACP flow was 8.3 +/- 2.3 mL x kg(-1) x min(-1). Five patients (10.9%) had temporary postoperative neurologic dysfunction. There was no permanent neurologic dysfunction. Three patients died within 30 days postoperatively, and the 1-month mortality rate was 6.5%. All of the surviving patients were followed for 24.9 +/- 18.0 months (range, 1 to 63). There were no deaths or severe complications during the follow-up.


CONCLUSIONS
Cannulation of the innominate artery with a side graft is safe and effective in arch surgery.
Huang
Fang Jiong
FJ
Cardiac Surgery Division, Beijing Institute of Heart, Lung and Vascular Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China.
Wu
Qiang
Q
Ren
Chang Wei
CW
Lai
Yong Qiang
YQ
Yang
Sheng
S
Rui
Qi Jin
QJ
Xu
Shang Dong
SD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D016122:Brachiocephalic Trunk / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002404:Catheterization / Q000379:methods*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult