Application of a modified perfusion strategy via anastomosis of the innominate artery with a 10-mm artificial vascular graft in acute type A aortic dissection

Background Acute type A aortic dissection (ATAAD) necessitates emergent surgery with optimal cerebral protection. Traditional axillary artery cannulation carries risks of brachial plexus injury and inadequate perfusion. This study evaluates a modified technique using a 10-mm vascular graft anastomosed to the innominate artery to improve cerebral and systemic perfusion. Methods We retrospectively analyzed data from 94 consecutive ATAAD surgical patients between May 2024 and May 2025. All patients underwent hypothermic circulatory arrest (HCA) combined with antegrade cerebral perfusion (ACP). Perfusion was established via end-to-side anastomosis of a 10-mm straight artificial vascular graft to the innominate artery, through which both systemic arterial perfusion and ACP were conducted. Results In-hospital mortality was 14.89%. Mean operative times included cardiopulmonary bypass (171.27 ± 43.65 min) and circulatory arrest (25 min). Complications included stroke (10.64%), tracheostomy (17.02%), and acute kidney injury (23.40%). No upper limb ischemia or vascular injuries occurred. Conclusions The modified perfusion strategy utilizing innominate artery anastomosis with an artificial vascular graft is a safe, effective, and technically reliable method. It provides excellent cerebral perfusion, unobstructed surgical visibility, and avoids upper limb ischemic complications, making it worthy of clinical promotion.