Resuscitating the chimney graft-to-innominate artery for straightforward cannulation during infancy.

Arterial cannulation with a chimney polytetrafluoroethylene (PTFE) graft to the innominate artery is commonly used for antegrade cerebral perfusion during neonatal aortic arch surgery [1, 2]. When properly retained and prepared prior to sternal closure, resuscitation of the PTFE graft-to-innominate artery can be performed months later during sternal re-entry. It is a safe and reproducible technique for expeditious arterial cannulation at stage II palliation in single ventricle patients or complete intra-cardiac repair in biventricular lesions. We report our experience utilizing this technique successfully during reoperation in 90/92 patients with no adverse thromboembolic events identified. Innominate artery cannulation with a chimney PTFE graft is commonly utilized during complex neonatal arch reconstruction (Norwood stage I palliation, hypoplastic or interrupted aortic arches, and hybrid comprehensive stage I and II procedures) to deliver antegrade cerebral perfusion. While graft recannulation can potentially be performed in the immediate post-operative period for emergency ECMO deployment, reuse of the graft for cardiopulmonary bypass during subsequent reoperation is typically not considered, and has not been found in our literature search. We describe a safe and reproducible technique for resuscitating the PTFE graft-to-innominate artery, after being placed at the time of initial neonatal surgery, months later, which avoids the need for extensive dissection of a reconstructed aorta, providing prompt arterial access for CPB. In our experience utilizing this technique, the PTFE-to-innominate artery graft was successfully resuscitated and used for CPB at the reoperation in 90/92 (97.8%) patients, with no adverse thromboembolic events identified.