Aortic cannulation in complex aortic disease: playing or planning on fear

The quest for the best strategy for arterial cannulation in the setting of complex proximal and arch aneurysm surgery remains elusive. Several cannulation strategies have been proposed to establish cardiopulmonary bypass (CPB) during aortic arch aneurysm surgery. Those strategies have direct influence on patients’ post-operative outcomes. In current era of stringent evidence synthesis and with available monitoring tools for different organs and various methods for organ protection, it is imperative that a deliverable strategy for cannulation in complex proximal aortic aneurysm is employed. However, due to scarcity of robust evidence and in a climate where randomized control trials to establish comparative outcomes between central cannulation versus peripheral cannulation are difficult to set up, our understanding is very much limited to observational data and discretional experiences. In this review we aim to illustrate comprehensively the concrete evidence most suitable strategy for arterial cannulation in proximal and arch of the aorta pathology and drawing on the conflicting reports and their correlation to quality outcomes.