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J Thorac Cardiovasc Surg 2006;132:1398-1403
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Carotid artery cannulation in aortic surgery

^a Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
^b Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication April 19, 2006; revisions received July 7, 2006; accepted for publication July 12, 2006.

^_* Address for reprints: Paul Urbanski, MD, Herz- und Gefaess-Klinik, Salzburger Leite 1, 97616 Bad Neustadt, Germany. (Email: p.urbanski{at}kardiochirurg.de).

OBJECTIVE: Carotid artery cannulation was initially established at our clinic for surgery of acute aortic dissection, and it became the standard approach for procedures in which circulatory arrest is necessary. The aim of the study was to evaluate this method’s efficiency regarding postoperative outcomes after the first 100 procedures.

METHODS: Between July 2002 and October 2005, 100 patients underwent aortic surgery using carotid artery cannulation by a side graft for arterial return with a mean flow rate of 4.6 ± 0.5 L/min. There were 27 patients with acute and 2 with chronic type A aortic dissection. Sixteen patients had had prior cardiac surgery. During circulatory arrest, the arterial line was used for unilateral cerebral perfusion in moderate hypothermia (mean rectal temperature 28°C ± 1.6°C) with a mean flow rate of 0.85 ± 0.2 L/min.

RESULTS: Carotid artery cannulation offered adequate arterial return in all patients. In no case was a switch to another cannulation site necessary for arterial return. Furthermore, no complications related to the cannulation site were observed. One patient with acute dissection and 1 with chronic aneurysm died during the early postoperative course. Thus, 30-day mortality was 2.0% for the whole group and 3.7% for the dissection group. Two patients with severe calcification of the aortic valve had strokes. There were no strokes in the dissection group, although there were preoperative signs of cerebral malperfusion in 4 patients.

CONCLUSIONS: Carotid artery cannulation is a fast, safe, and efficient method of arterial cannulation even in very obese patients. In addition, it simplifies the procedure of unilateral cerebral perfusion through the arterial line during circulatory arrest, making it completely unnecessary to interrupt cerebral perfusion.

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Discussion
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