Long-term outcomes of common carotid artery cannulation for elective aortic surgery-a follow-up study.

Background: The selection of the cannulation site for elective aortic surgery is mostly an individual choice based on the surgeon's experience and the surgical strategy. We evaluated the long-term outcomes of right common carotid artery (CCA) cannulation using a side graft to establish unilateral selective antegrade cerebral perfusion (uSACP).

Methods: We reviewed the records of 343 patients who underwent elective ascending aortic or aortic arch surgery between 2013 and 2020. One hundred aortic procedures were performed using the right CCA as the sole arterial cannulation site under moderate hypothermic circulatory arrest (MHCA). Cross-validated least absolute shrinkage and selection operator (LASSO) and stepwise Cox regression were applied to model the effects of cannulation sites on adverse outcomes. Kaplan-Meier analysis compared mortality in the treatment group with that in the general population.

Results: The mean patient age was 65.9±9.5 years (81% male). The mean MHCA temperature was 27.1±5.1 ℃, and the average uSACP duration was 13.6±7.7 minutes. The early mortality and stroke rates were 1% and 4%, respectively. After a median of 5.4 follow-up years, seven patients suffered stroke, with 92% survival at 6 years, similar to an age- and gender-matched general population (log-rank P=0.50). Multivariable analysis revealed that age at surgery was the only significant predictor of late stroke or death [hazard ratio (HR) =1.083; P=0.01; c-index 0.683). Control Doppler ultrasound examination after a median of 2.3 years found no evidence of injury or dissection of the right CCA.

Conclusions: Cannulation of the right carotid artery is a safe, feasible, and practical adjunct technique for proximal aortic surgery that generates comparable short- and long-term results. Careful patient selection and techniques are essential to minimize risk.