Efficacy and safety of the Direct Cannulation of the Innominate Artery (DCIA) in patients undergoing hemi-arch replacement

Abstract

Background: Maintaining selective antegrade cerebral perfusion (SACP) in cases mandating deep hypothermic circulatory arrest (DHCA) is the key to preventing major neurological insults.
Objective: The goal of this study was to compare the applicability of direct cannulation of the innominate artery (DCIA) to traditional cannulation using femoral artery side graft (FASG) in patients undergoing open arch operations using adequately sized arterial cannulas.
Methods: The hospital records of 108 consecutive patients who underwent open-arch surgeries at Cairo, and Beni-Suef University hospitals from January 2021 to December 2024 were retrospectively collected and analyzed. We compared pre-, intra-, and post-operative data between patients who underwent conventional FASG (58 patients) and those who were operated on using the DCIA (50 patients) technique.
Results: DCIA showed significantly shorter total operation time (253±134 minutes vs. 318±152 minutes), cardiopulmonary bypass (CPB; 180±37 vs. 200±57), aortic cross-clamp (ACC; 114±52 vs. 154±98), and circulatory arrest time (CA; 15.08±5.25 vs. 20.18±10.35), besides a significantly lower lactate level at the end of the operation (4.20 ± 2.28 vs. 7.33±3.71 mmol). Significantly fewer patients in the DCIA group experienced acute kidney injury and permanent neurologic insults after surgery (1 vs. 8 and 2 vs. 11, respectively). Among the same group, the number of patients who experienced prolonged Mechanical Ventilation (MV), prolonged intensive care unit (ICU) stays, and hospital stays was significantly lower (3 vs. 15, 5 vs. 18, and 5 vs. 19, respectively). The FASG group's total number of early fatalities is far higher than the other group's (7 vs. 1). Although not statistically significant, the FASG had a higher incidence of local wound and vascular problems as well as the need for packed red blood cell transfusion.
Conclusion: Direct cannulation of the innominate artery provided a safe and efficient method of maintaining optimum cerebral perfusion in patients mandating DHCA for open arch repair, and it should be considered as a good alternative to avoid the potential risks of the other conventional methods.