Direct innominate artery cannulation: An alternate technique for antegrade cerebral perfusion during aortic hemiarch reconstruction Arminder S. Jassar,

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Direct innominate artery cannulation: An alternate technique for antegrade cerebral perfusion during aortic hemiarch reconstruction Arminder S. Jassar, MBBS, Prashanth Vallabhajosyula, MD, MS, Joseph E. Bavaria, MD, Jacob Gutsche, MD, Nimesh D. Desai, MD, PhD, Matthew L. Williams, MD, Rita K. Milewski, MD, PhD, W. Clark Hargrove, MD, Wilson Y. Szeto, MD The Journal of Thoracic and Cardiovascular Surgery Volume 151, Issue 4, Pages 1073-1078 (April 2016) DOI: 10.1016/j.jtcvs.2015.11.027 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Nine-French short-tipped cannula used for cannulating the innominate artery for antegrade cerebral perfusion. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1073-1078DOI: (10.1016/j.jtcvs.2015.11.027) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Innominate artery is circumferentially encircled with an umbilical tape and retracted caudally and a 9-Fr short-tipped cannula is inserted into the innominate artery. B, Under circulatory arrest, proximal aorta is resected, including the site of the aortic cannula. Proximal innominate artery is clamped and antegrade cerebral perfusion is delivered via the 9-Fr cannula. Note that the innominate artery cannula is very low profile and causes no obstruction of the surgical field. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1073-1078DOI: (10.1016/j.jtcvs.2015.11.027) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A and B, The distal aortic anastomosis is performed with a running suture while antegrade cerebral perfusion is delivered via the innominate artery. C, After distal aortic anastomosis is complete, the innominate artery cannula is removed and the aortic graft is cannulated to re-establish cardiopulmonary bypass. Proximal reconstruction is completed. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1073-1078DOI: (10.1016/j.jtcvs.2015.11.027) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Innominate artery is cannulated directly to deliver antegrade cerebral perfusion. The Journal of Thoracic and Cardiovascular Surgery 2016 151, 1073-1078DOI: (10.1016/j.jtcvs.2015.11.027) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions