Extrathoracic Carotid Artery Cannulation in Cardiovascular Reoperations

Cardiac reoperations, especially those involving the aortic arch, pose a significant challenge due to extensive adhesions and an increased risk of injury during resternotomy. In such cases, initiating cardiopulmonary bypass (CPB) through peripheral access before sternotomy may enhance surgical safety. This report presents two cases in which extracorporeal carotid artery cannulation was successfully applied to establish CPB and facilitate antegrade cerebral perfusion (ACP). The first case involved a patient with Type A aortic dissection following a previous Bentall procedure, where femoral and axillary access were considered unsuitable due to anatomical and pathological conditions. The second case involved a complicated coronary artery bypass surgery due to peripheral artery disease and subclavian occlusion. In both cases, CPB was safely initiated via an 8 mm PTFE graft anastomosed to the left carotid artery with venous drainage through the femoral vein. No early neurological or systemic complications were observed postoperatively. These cases demonstrate that extrathoracic carotid artery cannulation is a safe and effective alternative when traditional cannulation sites are unsuitable, providing both safe CPB initiation and reliable ACP in complex reoperations.