Decreased cerebral emboli during distal aortic arch cannulation: A randomized clinical trial

Background: Cerebral emboli occur during cardiopulmonary bypass and are a principal cause of postoperative neurologic dysfunction. We hypothesized that arterial cannulation of the distal aortic arch, with placement of the cannula tip beyond the left subclavian artery, will result in fewer cerebral microemboli than conventional cannulation of the ascending aorta, Methods: Patients undergoing coronary bypass surgery with a single crossclamp technique were randomized to receive cannulation of the distal aortic arch (n = 17) or standard cannulation of the ascending aorta (control group, n = 17), Trendelenburg positioning was used whenever possible. Cerebral emboli were quantified by continuous transcranial Doppler monitoring of the middle cerebral artery. Results: Baseline demographics were similar for the 2 groups of patients, including cardiopulmonary bypass and crossclamp times. Cerebral microemboli were detected during cardiopulmonary bypass in all patients, with a range of 17 to 627 emboli, The total number of detected emboli was lower in the arch cannulation group (152 +/- 33, mean +/- standard error of the mean) than in the conventional cannulation group (249 +/- 35, P = .04), Embolization rates were lower in distal arch patients than in control patients during cardiopulmonary bypass (2.0 +/- 0.3 vs 4.2 +/- 0.9 per minute, respectively, P = .03), Reduction in cerebral emboli by distal arch cannulation was most pronounced during perfusionist interventions. Conclusions: Cannulation of the distal aortic arch results in less cerebral microembolism than conventional cannulation of the ascending aorta. Provided it is performed safely, distal arch cannulation may be an important surgical option for patients with severe atherosclerosis of the ascending aorta.