The impact of arterial cannulation strategy on carotid perfusion during cardiopulmonary bypass: A computational fluid dynamics analysis from the perspective of vascular anatomy

<i>Introduction:</i> Cardiopulmonary bypass (CPB) is utilized during cardiovascular surgery to maintain organ oxygen supply and blood perfusion instead of cardiopulmonary function. Three primary methods of artery cannulation used for CPB include ascending aortic cannulation (AscAoC), right axillary artery cannulation (rAxAC), and femoral artery cannulation (FAC).<i>Methods:</i> In this study, computational fluid dynamics simulation technology was employed to analyze aorta and main branches of 62 patients undergoing CPB with different arterial cannulation schemes, observing carotid artery (CarA) perfusion and characteristics.<i>Conclusions:</i> Results indicate that the total perfusion of bilateral CarAs using the three cannulation methods was sufficient when there was no significant variation in arterial morphology. Without considering the peripheral resistance and the body's autoregulatory function, the right CarA was less perfused than the left CarA under AscAoC and rAxAC, leading to perfusion imbalance. Especially heteroplastic patients with rAxAC may be at risk of the right CarA hypoperfusion during CPB. FAC provides balanced and adequate perfusion of both hemispheres without stenosis or dissection of the aorta.