Cannulation Strategies for Aortic Arch Surgery
Abstract
1. Introduction
2. Cannulation Options
2.1. Right Axillary Artery
2.2. Innominate Artery
2.3. Left Axillary Artery
2.4. Bilateral Axillary Artery
2.5. Femoral Artery
2.6. Double-Arterial Cannulation
3. Conclusions
4. Future Directions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ACC/AHA | American College of Cardiology/American Heart Association |
ACP | Antegrade cerebral perfusion |
ATAAD | Acute Type A Aortic Dissection |
CPB | Cardiopulmonary bypass |
DHCA | Deep hypothermic circulatory arrest |
EACTS | European Association of Cardiothoracic Surgery |
SCP | Selective cerebral perfusion |
TEVAR | Thoracic endovascular aortic repair |
TND | Temporary neurological deficit |
PND | Permanent neurological deficit |
References
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Advantages | Disadvantages | |
---|---|---|
Right axillary artery | Safe effective ACP | Dissection (direct cannulation) |
Deflects emboli from ascending aorta | Arm ischemia (direct cannulation) | |
Rarely dissected | ||
↓ early embolic stroke | ||
↓ early operative mortality | ||
Utility in redo complex aortic surgery | ||
↓ complication rate | ||
Pressure-controlled cerebral perfusion | ||
↓ transient neurologic dysfunction rate | ||
Innominate artery | Single median sternotomy incision | Often involved in aortic dissection |
↓ operative time | ||
High flows on CPB | ||
Use of larger caliber artery | ||
Safe and effective ACP | ||
Low temporary neurological dysfunction | ||
Left axillary artery | Utility in dissected right axillary and femoral arteries | Similar to right axillary disadvantages |
SCP with direct left common carotid artery | ||
Utility in re-operative setting in total arch reconstruction | ||
Bilateral axillary artery | Safe ACP | Arm ischemia |
Pectoral atrophy | ||
Femoral artery | Safe and effective | Secondary cannulation for SCP |
Increased micro-emboli load due to retrograde aortic flow | ||
Double-arterial cannulation | Overcomes drawbacks of single cannulation technique | Disadvantages of the sites utilized |
Both cerebral and lower body perfusion during arch reconstruction |
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Rahman, I.; Ali, J.; De Silva, R. Cannulation Strategies for Aortic Arch Surgery. J. Cardiovasc. Dev. Dis. 2025, 12, 360. https://doi.org/10.3390/jcdd12090360
Rahman I, Ali J, De Silva R. Cannulation Strategies for Aortic Arch Surgery. Journal of Cardiovascular Development and Disease. 2025; 12(9):360. https://doi.org/10.3390/jcdd12090360
Chicago/Turabian StyleRahman, Ishtiaq, Jason Ali, and Ravi De Silva. 2025. "Cannulation Strategies for Aortic Arch Surgery" Journal of Cardiovascular Development and Disease 12, no. 9: 360. https://doi.org/10.3390/jcdd12090360
APA StyleRahman, I., Ali, J., & De Silva, R. (2025). Cannulation Strategies for Aortic Arch Surgery. Journal of Cardiovascular Development and Disease, 12(9), 360. https://doi.org/10.3390/jcdd12090360