Semin cardiothorac vasc anesth

Arterial Cannulation Considerations

The surgical procedure and strategy will dictate the arterial 

cannulation technique required. The options for cannula-

tion site include ascending aorta, femoral artery, and axil-

lary artery and are outlined in Table 1. The ascending aorta 

is commonly used for procedures that include an upper- or 

lower-hemisternotomy—for example, aortic or mitral 

valve procedures. The aorta can also be cannulated directly 

via the thoracotomy incision.

35

The femoral artery is often used for procedures that uti-

lize a right anterolateral minithoracotomy incision: for 

example, the mitral valve, atrial septal defect, or tricuspid 

valve repair procedures. Recently an increased risk of neu-

rological complications has been reported with the use of 

femoral retrograde perfusion versus central antegrade per-

fusion.

36

 However, others have advocated for the screening 

of patients at risk for aortoiliac atherosclerosis with con-

trast-enhanced multidetector CT, with avoidance of femo-

ral cannulation in patients with grade IV/V atheroma.

37

In patients who already have preoperative coronary 

angiography, our current strategy is to obtain multidetector 

CT angiography of the chest, abdomen, and pelvis in all 

patients older than 65 years of age or those having a sig-

nificant history of smoking, hypertension, or peripheral 

arterial disease. Our evolving strategy is to obtain preop-

erative ECG-gated cardiac CT angiography coupled with a 

Table 1.  Preferred Cannulation Sites by Procedure Type.

a

Aortic Valve Replacement

Mitral Valve Repair/ 

Replacement

Tricuspid Valve Repair/Replacement, 

ASD Closure

Incision