Aortic and innominate cannulations are equally safe in redo aortic surgery.
- 1Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.
- 2Division of Cardiothoracic Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.
Abstract
Objective
Chest reentry poses challenges for establishing cardiopulmonary bypass. This study aimed to compare postoperative neurologic outcomes between aortic (AC) and innominate cannulation (IC) in redo aortic surgery.Methods
We retrospectively reviewed 201 patients undergoing redo sternotomy for aortic aneurysm repair from 2010 to 2024. Patients were stratified by cannulation site: AC (n = 119) or IC (n = 34); 48 patients who underwent other approaches were excluded. Demographics, intraoperative variables, and postoperative outcomes were compared. Propensity-score matching (PSM), logistic regression, and Kaplan-Meier analyses were performed.Results
Median age was 62.4 years; 75.8% were male. Before PSM, patients in the AC group had a lower smoking rate (38.7% vs 64.7%, P = .012) but a greater incidence of partial/total arch replacement (68.9% vs 23.5%, P < .001) compared with those in IC. IC was associated with lower nadir temperature (26.9 vs 27.5 °C, P = .044), longer crossclamp time (108.5 vs 87 minutes, P < .001), and more antegrade cerebral perfusion alone (91.2% vs 29.4%, P < .001). IC required more intraoperative fresh-frozen plasma (6 vs 4 units, P = .001). After PSM, crossclamp time did not differ, but IC had longer circulatory arrest (13 vs 9.4 minutes, P = .004) and lower end left cerebral oxygen saturation (67% vs 70%, P = .021). Postoperative stroke, encephalopathy/delirium, and mortality were similar. In multivariable regression analysis, cannulation site was not associated with postoperative stroke. Ten-year survival rates were 66.6% for AC and 65.0% for IC (P log-rank = .551).Conclusions
AC and IC are safe in redo sternotomy for aortic surgery, with similar neurologic and survival outcomes reported. Surgeons may choose either approach on the basis of preference and patient anatomy.
Related
- Dynamic left main occlusion after aortic valve surgery: recognizing extrinsic compression by aortic root pseudoaneurysm—a case report
- Surgery that looks like transcatheter aortic valve implantation: the transaxillary concept for minimally invasive aortic valve replacement in 1,848 consecutive patients
- Transaxillary access for ascending aortic and root surgery: a single-center comparison with full and partial sternotomy
- Surgical thrombectomy with preservation of the bioprosthetic aortic valve in obstructive valve thrombosis during complex redo cardiac surgery
- Application of Non-Invasive Cardiac Output Monitoring in Enhanced Recovery After Surgery for Patients With Acute Type A Aortic Dissection
BibTeX
@article{wu2026aortic,
title = {{Aortic and innominate cannulations are equally safe in redo aortic surgery.}},
author = {Bo Chang Brian Wu and Meng-Han Tsai and Drake S Rosenberg and Kyndall Hadley and Joseph C Cleveland and Muhammad Aftab and T Brett Reece},
journal = {JTCVS open},
year = {2026},
month = aug,
doi = {10.1016/j.xjon.2026.102086},
url = {https://europepmc.org/article/MED/42948126},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Aortic and innominate cannulations are equally safe in redo aortic surgery.
AU - Bo Chang Brian Wu
AU - Meng-Han Tsai
AU - Drake S Rosenberg
AU - Kyndall Hadley
AU - Joseph C Cleveland
AU - Muhammad Aftab
AU - T Brett Reece
PY - 2026
DA - 2026/08/27
JO - JTCVS open
DO - 10.1016/j.xjon.2026.102086
UR - https://europepmc.org/article/MED/42948126
AB - Objective Chest reentry poses challenges for establishing cardiopulmonary bypass. This study aimed to compare postoperative neurologic outcomes between aortic (AC) and innominate cannulation (IC) in redo aortic surgery.Methods We retrospectively reviewed 201 patients undergoing redo sternotomy for aortic aneurysm repair from 2010 to 2024. Patients were stratified by cannulation site: AC (n = 119) or IC (n = 34); 48 patients who underwent other approaches were excluded. Demographics, intraoperative variables, and postoperative outcomes were compared. Propensity-score matching (PSM), logistic regression, and Kaplan-Meier analyses were performed.Results Median age was 62.4 years; 75.8% were male. Before PSM, patients in the AC group had a lower smoking rate (38.7% vs 64.7%, P = .012) but a greater incidence of partial/total arch replacement (68.9% vs 23.5%, P < .001) compared with those in IC. IC was associated with lower nadir temperature (26.9 vs 27.5 °C, P = .044), longer crossclamp time (108.5 vs 87 minutes, P < .001), and more antegrade cerebral perfusion alone (91.2% vs 29.4%, P < .001). IC required more intraoperative fresh-frozen plasma (6 vs 4 units, P = .001). After PSM, crossclamp time did not differ, but IC had longer circulatory arrest (13 vs 9.4 minutes, P = .004) and lower end left cerebral oxygen saturation (67% vs 70%, P = .021). Postoperative stroke, encephalopathy/delirium, and mortality were similar. In multivariable regression analysis, cannulation site was not associated with postoperative stroke. Ten-year survival rates were 66.6% for AC and 65.0% for IC (P log-rank = .551).Conclusions AC and IC are safe in redo sternotomy for aortic surgery, with similar neurologic and survival outcomes reported. Surgeons may choose either approach on the basis of preference and patient anatomy.
SN - 2666-2736
ER -