Antegrade cerebral perfusion (ACP) is widely used during congenital aortic arch reconstruction; however, variability persists regarding cannulation strategies. Direct innominate artery cannulation may simplify arterial access while maintaining reliable cerebral perfusion, but reports describing its systematic use remain limited.

A retrospective single-center study was performed including consecutive patients undergoing congenital aortic arch reconstruction with ACP established through direct innominate artery cannulation between December 2022 and February 2026. All procedures were performed using the same cannulation strategy by the same attending congenital cardiac surgeon. Demographic, operative, perfusion, and postoperative variables were analyzed.

Twenty-five patients underwent aortic arch reconstruction using direct innominate artery cannulation for ACP. Age ranged from 6 to 971 days and weight from 2.0 to 12.7 kg. Diagnoses included coarctation complex with transverse arch hypoplasia, interrupted aortic arch, Taussig-Bing anomaly, transposition of the great arteries, recoarctation with arch hypoplasia, complete atrioventricular septal defect, and borderline left ventricle. Associated procedures included ventricular septal defect closure and arterial switch operation. Mean cardiopulmonary bypass time was 153 min, mean cross-clamp time was 67 min, and mean ACP duration was 24 min. No cannulation-related vascular injuries or conversions occurred. No structural neurologic injury was identified. One patient developed transient neurologic symptoms without sequelae. Two hospital deaths occurred, neither attributable to the cannulation technique.

Direct innominate artery cannulation represents a safe, reproducible, and technically straightforward strategy for ACP during congenital aortic arch reconstruction. Consistent use without major modification supports its reliability across a heterogeneous spectrum of congenital arch procedures.