Hydrodynamics of aortic arch vessels during perfusion through the right subclavian artery

Background. Performing subclavian artery cannulation in patients with an at herosclerotic ascending aorta or acute aortic dissection is of growing inte rest. To increase knowledge about pressure and flow distribution in the arc h vessels, we investigated the in vitro perfusion characteristics in right subclavian artery cannulation. Methods. Pressures and how rates in the arch vessels of an aortic arch mode l were measured during perfusion through the right subclavian artery with d ifferent geometries and varying flow rates. Flow visualization was performe d by laser light. Results. In normal subclavian artery geometries, pressure and flow showed a significant increase in only the right common carotid artery (8 mm Hg and 25.5 mL/min, respectively, at 5.5 L/min pump flow). In cases of 50% stenosi s at the right subclavian artery origin, a reduction of pressure and flow ( 6 mm Hg and 22.5 mL/min, respectively, at 5.5 L/min pump flow) in the right carotid artery caused by a suction effect was observed. Conclusions. Right subclavian artery cannulation provides a valuable altern ative for ascending aortic cannulation, enabling nearly balanced arch vesse l perfusion. Stenosis at the right subclavian artery origin carries the pot ential risk of slightly reduced perfusion of the right common carotid arter y with questionable clinical relevance, (C) 2000 by The Society of Thoracic Surgeons.