Objectives: Thoracic aortic surgery bears a high risk of neurological complications due to brain malperfusion or embolization of atheroma. The arterial cannulation strategy for cardiopulmonary bypass (CPB) in elective thoracic aortic surgery as well as in acute type A dissection (ATAAD) has been modified over the last decades. But there is an ongoing discussion about the optimal arterial cannulation site.
Methods: We analyzed a cohort of 668 patients who underwent thoracic aortic surgery in our university heart center from 01/2000 until 05/2020. Depending on the cannulation site, we focused the incidence of neurological complications that were categorized in major (ischemic stroke/bleeding), minor (PRIND/TIA), and postoperative delirium.
Result: In all patients with thoracic aortic surgery, 4.6% (31/668) of patients suffered from neurological deficits, major deficits occurred in 2.7%, minor in 1.9%, and delirium occurred in 18.1%. Cannulation of the innominate artery/brachiocephalic trunk (BT) was used in 22.6% of all cases (151/668).
Although major neurological deficits occurred in 3.4% (23/668) of cases with non-BT cannulation, an incidence of only 1.2% (8/668) could be observed in patients with BT cannulation.
In the subgroup of ATAAD (all cannulation sites), an incidence of major neurological deficits occurred in 6.6%. BT cannulation was used in 40.4% of cases (116/287) and an incidence of major neurological deficits occurred in 1.7% (5/287). In patients with non-BT cannulation, the incidence of major neurological deficits was threefold higher (4.9%, 14/287).
Conclusion: The risk of severe neurologic complications in elective as well as acute thoracic aortic surgery is substantially reduced by using BT cannulation. We recommend the brachiocephalic trunk as the cannulation site of choice.
