title: Direct innominate artery cannulation: An alternate technique for antegrade cerebral perfusion during aortic hemiarch reconstruction.
abstract: OBJECTIVE
  We describe an alternate technique for establishing antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest via direct, central cannulation of the innominate artery.
  
  
  METHODS
  From 2009 to 2015, 100 elective hemiarch reconstructions for proximal aortic aneurysms were performed under moderate hypothermic circulatory arrest (MHCA). Cerebral perfusion was instituted with ACP via direct cannulation of the innominate artery.
  
  
  RESULTS
  Mean patient age was 63 ± 13 years (72 men; 72%). Mean MHCA temperature was 27.3°C ± 1.0°C (median, 28°C). Mean ACP time was 17 ± 4 minutes and mean crossclamp time was 134 ± 42 minutes. Proximal reconstruction included root replacement with composite valved graft (n = 47), valve sparing root reimplantation (n = 16), and aortic valve replacement (n = 19). In-hospital 30-day mortality (n = 1; 1%), stroke (1; 1%), reversible ischemic neurologic deficit (n = 1; 1%), coma (n = 0), and renal failure (n = 1; 1%) rates were low. There was no incidence of injury or dissection of the innominate artery.
  
  
  CONCLUSIONS
  Direct, central innominate artery cannulation for ACP yields excellent outcomes. This technique is safe, provides excellent cerebral protection during circulatory arrest and simplifies the circulatory management strategy for elective ascending aortic and hemiarch reconstruction.
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Arminder S
authors.initials: AS
authors.lastname: Jassar
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: Department of Anesthesia, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Jacob
authors.initials: J
authors.lastname: Gutsche
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Williams
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Rita K
authors.initials: RK
authors.lastname: Milewski
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: W Clark
authors.initials: WC
authors.lastname: Hargrove
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. Electronic address: Wilson.Szeto@uphs.upenn.edu.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016122:Brachiocephalic Trunk / Q000503:physiopathology*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012039:Regional Blood Flow; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic arch; cerebral perfusion; moderate hypothermic circulatory arrest