Accidental regional left subclavian artery perfusion revealed by roller pump-synchronous arterial pressure waveform during ascending aortic cannulation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Mitral regurgitation complicated by accidental regional left subclavian artery perfusion during ascending aortic cannulation (n=1). Intervention: Withdrawal of ascending aortic arterial cannula by 1.5 cm. Primary outcome: Resolution of accidental regional left subclavian artery perfusion and normalization of left radial arterial pressure waveform.

Takanori Kohyama; Hideyuki Nakagawa

doi:10.1007/s00540-026-03942-2

October 29, 2026Journal of AnesthesiaOpen Access

Accidental regional left subclavian artery perfusion revealed by roller pump-synchronous arterial pressure waveform during ascending aortic cannulation

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Key result

Aortic cannula withdrawal by 1.5 cm resolves accidental left subclavian artery perfusion.

n=1

Key Points

To report a case of accidental regional left subclavian artery perfusion during cardiopulmonary bypass identified by an abnormal roller pump-synchronous arterial line waveform.
Clinical case evaluation of a 49-year-old male undergoing minimally invasive mitral valve plasty with cardiopulmonary bypass established via ascending aortic cannulation using the Seldinger technique (N=1).
Hemodynamic status was monitored using a left radial arterial catheter, transesophageal echocardiography, pulmonary artery catheter, and bilateral cerebral regional oxygen saturation.
Upon initiating cardiopulmonary bypass, the left radial arterial waveform exhibited an abnormal serrated pattern at 252 beats per minute, matching twice the roller pump speed of 126 revolutions per minute rather than the patient heart rate of 100 beats per minute.
Transesophageal echocardiography demonstrated rapid pulsatile flow in the left subclavian artery, and withdrawing the aortic cannula by approximately 1.5 cm normalized the pressure waveform without postoperative complications.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient (aged 49 years) with mitral regurgitation undergoing minimally invasive mitral valve plasty via right thoracotomy with ascending aortic cannulation.

I

Intervention

Ascending aortic arterial cannulation (inserted approximately 5 cm into the aortic lumen through the third intercostal space using the Seldinger technique) for cardiopulmonary bypass with a roller pump (126 revolutions per minute, target pump flow index 2.6 L/min/m2), followed by withdrawal of the arterial cannula by approximately 1.5 cm upon detection of accidental left subclavian artery perfusion.

O

Outcome

Normalization of the left radial arterial pressure waveform and restoration of pulsatile flow in the left subclavian artery to synchronicity with the intrinsic cardiac cycle immediately following cannula withdrawal.safety

Limitations

Single patient case report
Visualization of the aortic arch branches and arterial cannula tip using transesophageal echocardiography was technically challenging
Cerebral regional oxygen saturation monitoring did not provide an early indication of arterial cannula malposition
Routine radial arterial pressure monitoring and pulse oximetry may not detect regional perfusion of the left common carotid artery
Visualization of the aortic arch branches and confirmation of the arterial cannula tip position using transesophageal echocardiography (TEE) was technically challenging.
Arterial cannula insertion depth was estimated based on the surgeon's experience rather than direct visualization.
Cerebral regional oxygen saturation (rSO2) monitoring did not provide an early indication of arterial cannula malposition.

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Implication

Continuous radial arterial pressure waveform analysis allows instantaneous recognition of accidental regional left subclavian artery perfusion caused by deep ascending aortic cannulation using the Seldinger technique during cardiopulmonary bypass.

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Cite This Study

Kohyama et al. (2026) conducted a case report in Mitral regurgitation complicated by accidental regional left subclavian artery perfusion during ascending aortic cannulation (n=1). Withdrawal of ascending aortic arterial cannula by 1.5 cm was evaluated on Resolution of accidental regional left subclavian artery perfusion and normalization of left radial arterial pressure waveform. Withdrawal of the ascending aortic cannula by 1.5 cm immediately resolved accidental left subclavian artery perfusion detected by a 252 bpm roller pump-synchronous arterial waveform.

synapsesocial.com/papers/6aee6c1271a7594806220d1a https://doi.org/10.1007/s00540-026-03942-2

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Accidental regional left subclavian artery perfusion revealed by roller pump-synchronous arterial pressure waveform during ascending aortic cannulation

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Accidental regional left subclavian artery perfusion revealed by roller pump-synchronous arterial pressure waveform during ascending aortic cannulation

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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