Work

Aortic and innominate cannulations are equally safe in redo aortic surgery

Year: 2026

Type: article

Abstract: Objective Chest reentry poses challenges for establishing cardiopulmonary bypass (CPB). This study aims 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 2010-2024. Patients were stratified by cannulation site: AC (N = 119) or IC (N = 34), excluding 48 with other approaches. 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, AC had a lower smoking rate (38.7% vs. 64.7%, P=0.012) but a higher partial/total arch replacement (PAR/TAR) rate (68.9% vs. 23.5%, P<0.001) compared to IC. IC was associated with lower nadir temperature (26.9 vs. 27.5 °C, P=0.044), longer cross-clamp (108.5 vs. 87 min, P<0.001), and more antegrade cerebral perfusion alone (91.2% vs. 29.4%, P<0.001). IC required more intraoperative FFP (6 vs. 4 units, P=0.001). After PSM, cross-clamp time did not differ, but IC had longer circulatory arrest (13 vs 9.4 min, P=0.004) and lower end left cerebral oxygen saturation (67% vs. 70%, P=0.021). 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 =0.551). Conclusions Aortic and innominate cannulations are safe in redo sternotomy for aortic surgery, with similar neurological and survival outcomes. Surgeons may choose either approach based on preference and patient anatomy.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2026.102086