title: Innominate and Axillary Cannulation in Aortic Arch Surgery Provide Similar Neuroprotection.
abstract: BACKGROUND
  Contemporaneous trends in cerebral protection during aortic arch surgery include moderate hypothermia (22°C-28°C) and continuous antegrade cerebral perfusion (ACP). Innominate artery cannulation is a simplified, alternative route for ACP; however, clinical outcomes have yet to be evaluated against the gold standard of axillary cannulation.
  
  
  METHODS
  Between 2008 and 2015, 140 consecutive patients underwent hemiarch reconstruction with moderate hypothermia and continuous ACP at 2 institutions. Axillary cannulation was used in 74 patients (31.1% female, 64.8 ± 12.7 years) and the remaining 66 patients (24.2% female, 60.8 ± 10.5 years) had direct cannulation of the innominate artery for delivery of ACP.
  
  
  RESULTS
  Although there were no statistically significant differences in complications, neurological events were almost twice as frequent in innominate (19.7%) than in axillary (10.8%; P = 0.142) whereas prolonged mechanical ventilation was much more common with axillary (17.6%) vs innominate (7.6%; P = 0.078). There were no mortalities in the axillary group and 1 in the innominate group (0% vs 1.5%; P > 0.471) and no statistically significant differences in any other postoperative complications or hospital length of stay. There was a reduction in total operating room time in the innominate group (axillary 454 ± 115 minutes, innominate 318 ± 125 minutes; P < 0.001), and in the matched subgroup analysis of patients who underwent Bentall and hemiarch reconstruction (axillary 456 ± 109 minutes, innominate 370 ± 106 minutes; P = 0.003).
  
  
  CONCLUSIONS
  Axillary and innominate artery cannulation for ACP during proximal aortic arch reconstructive surgery resulted in similarly excellent neurological outcomes. Innominate artery cannulation might reduce total surgical time. Possible clinically relevant differences in neurological and respiratory complications require assessment in randomized controlled trials.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Western University, Lawson Health Research Institute, London, Ontario, Canada. Electronic address: Michael.Chu@lhsc.on.ca.
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Western University, Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Losenno
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Western University, Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Gelinas
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vinay
authors.initials: V
authors.lastname: Garg
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Dickson
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alana
authors.initials: A
authors.lastname: Harrington
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001366:Axillary Artery; D016122:Brachiocephalic Trunk; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control*; D002404:Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D061646:Operative Time; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome