title: Ascending aorta cannulation in acute type A aortic dissection.
abstract: OBJECTIVE
  Antegrade perfusion for type A acute aortic dissection prevents malperfusion and retrograde cerebral embolism during cardiopulmonary bypass. Prompt establishment of antegrade perfusion via ascending aorta may improve the surgical results of type A dissections, especially in the situations of hemodynamic instability. Thus, we evaluated the efficacy of use of the dissected ascending aorta as an alternative arterial inflow.
  
  
  METHODS
  Between 2002 and 2006, 32 patients underwent prosthetic graft replacement of the ascending aorta or hemiarch for acute type A aortic dissection. The ascending aorta was routinely cannulated, in addition to the femoral artery, with a heparin-coating flexible cannula for arterial inflow, using Seldinger technique, and by epiaortic ultrasonographic guidance (n=6). Antegrade systemic perfusion via ascending aorta was performed.
  
  
  RESULTS
  Ascending aorta cannulation was safely performed in all cases. There was no malperfusion or thromboembolism due to ascending aorta cannulation. Cardiopulmonary bypass was established within 30 min after skin incision. There was one in-hospital death due to duodenal bleeding (1/32=3.1%), two cases of cerebral infarction (2/32=6.3%), and one case of pulmonary embolism. Twenty-nine patients (29/32=90.6%) were discharged in New York Heart Association class I and have been followed up uneventfully for a mean of 17 months.
  
  
  CONCLUSIONS
  Antegrade perfusion via the ascending aorta was successfully performed with low mortality and morbidity. With ultrasound-guided Seldinger technique, ascending aorta cannulation has a potential to be a simple and safe option that enables rapid establishment of antegrade systemic perfusion in patients with acute type A aortic dissection.
authors.affiliation: Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi 321-0974, Japan. yosito_inoue@saimiya.com
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Inoue
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ueda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Taguchi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kashima
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Koizumi
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Takahashi
authors.forename: Issei
authors.initials: I
authors.lastname: Kiso
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011183:Postoperative Complications; D014463:Ultrasonography