Cannulation of innominate artery as an alternative to axillary artery in repair for type A aortic dissection

Background

The aim of this study was to compare innmoinate artery cannulation with axillary artery cannulation in the setting of repair of acute type A aortic dissection. The primary end point of this study was the difference in neurological complications. The difference in mortality, operative time and limb complications were the secondary end points.

Methods

Between January 2014 and January 2016, 30 patients operated upon in Kasr Al-Aini hospitals, Egypt were studied prospectively. All patients underwent repair of ascending aorta ± aortic arch for type A aortic dissection using open clamp technique and antegrade cerebral perfusion. Patients with dissected innominate artery were excluded from this study. Patients were divided randomly into two equal groups. Patients with axillary cannulation were allocated to group A, while patients with innominate artery cannulation were allocated to group B.

Results

Bentall operation was done in 6 patients in group A (40%) and 8 patients in group B (53.3%). Tirone David operation was done in 9 patients in group A (60%) and 7 patients in group B (46.6%). The Ischemic time was 147.3 ± 35.1 min in group A versus 138.3 ± 51.9 min in group B with no statistical significance. The operative time was obviously shorter (313.6 ± 23.48min) in the innominate artery group versus 348.3 ± 29.25 min in the axillary artery group with no statistical significance. One patient died in each group. One patient in group A had a transient cognitive dysfunction versus two patients in each group B. One patient in group A had a stroke. Two patients (13.3%) of the axillary group had a temporary upper limb parasthesia that resolved completely in 3 months. One patient (6.6%) in the same group had a superficial wound infection. No adverse events were reported with innominate artery grafting.

Conclusions

Innominate artery cannulation shortened the operative time and reduced complications related to the cannulation site as compared to axillary artery cannulation. It provided a safe alternative for antegrade cerebral perfusion as regards the incidence of neurological complications.