title: Central cannulation is safe in acute aortic dissection repair.
abstract: OBJECTIVE
  The site of cannulation for the repair of ascending aortic dissection remains controversial. It is not clear whether cannulation of the dissected vessel is safe or even preferred. We hypothesized that cannulation of the dissected aorta could be done safely with acceptable complication and mortality rates in this high-risk population.
  
  
  METHODS
  The charts of repairs of acute ascending aortic dissections (n = 70) from 1996 to 2005 were reviewed. Cannulation was accomplished in 24 patients via the dissected aorta (central) and in 46 patients through cannulation of the femoral or axillary artery (peripheral). All were converted to sidearm cannulation of the graft for reperfusion. Groups were compared on the basis of comorbidities in addition to mortality, complications, hospital stays and final disposition.
  
  
  RESULTS
  The groups were comparable on the basis of age and preoperative comorbidities. Similarly, there were no differences in bypass time, crossclamp time, or hypothermic circulatory arrest time between groups. Hospital mortality and postoperative complications, including stroke, were similar between groups, but the peripheral group experienced more cardiac events (peripheral 15% vs central 0%; P < .05) and higher mortality than the central group (peripheral 19.5% vs central 4.2%; P < .05).
  
  
  CONCLUSIONS
  Direct cannulation of the dissected aorta was safe compared with peripheral cannulation in these patients. Inasmuch as these data demonstrate that cannulation of the dissected ascending aorta is safe, this technique can be used to tailor the cannulation approach to specific anatomic and patient characteristics that might optimize postoperative outcomes in this disease entity.
authors.affiliation: University of Virginia, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Charlottesville, Va, USA. tbr5q@virginia.edu
authors.forename: T Brett
authors.initials: TB
authors.lastname: Reece
authors.forename: Curtis G
authors.initials: CG
authors.lastname: Tribble
authors.forename: Robert L
authors.initials: RL
authors.lastname: Smith
authors.forename: R Ramesh
authors.initials: RR
authors.lastname: Singh
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Peeler
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001366:Axillary Artery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome