In operations requiring a cardiopulmonary bypass (CPB), surgery for acute
ascending aortic dissection still has high morbidity and mortality. Known major
complications are impairment of consciousness and neurologic disability. To improve
outcomes, many methods have recently been introduced: varying degrees of systemic
hypothermia to increase the hypoxemic tolerance of the brain, and different arterial
cannulated sites for brain perfusion. Previously, the CPB was set up using femoral artery
cannulation with deep hypothermic circulatory arrest (DHCA) (16-18 °C). Because more
neurologic complications were found, other extra-perfusion methods with retrograde
cerebral perfusion from the superior vena cava have been used for years. Recently,
peripheral right subclavian and axillary artery cannulation have been used, and reported
outcomes seem better. Selective cerebral perfusion is another choice for peripheral
cannulation. Innominate artery cannulation has also recently become popular. Some
surgeons prefer central arterial cannulation, in which the approach is directly from the
dissected ascending aorta, to peripheral cannulation, in which the approach is through the
cardiac apex. Transapical cannulation consists of inserting the arterial cannula through the
apex and the aortic valve so that it lies in the sinus of Valsalva. In summary, cannulation
sites for CPB can be peripheral arteries or central arteries. Although we recommend using
axillary arterial cannulation, we discuss and summarize the advantages and disadvantages
of multiple methods of CPB, and compare clinical outcomes between the two cannulated
sites.
Keywords: Antegrade cerebral perfusion, Ascending aortic cannulation,
Ascending aortic dissection, Axillary artery cannulation, Brain protection,
Cardiopulmonary bypass, Central cannulation, Hypothermia, Hypothermic
circulatory arrest, Hypothermic circulatory arrest, Innominate artery cannulation,
moderate hypothermia, Perfusion flow, Peripheral cannulation, Retrograde
cerebral perfusion, Selective cerebral perfusion, Selective cerebral perfusion,
Subclavian artery cannulation, Superior vena cava, Transapical cannulation.
