Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience.
OBJECTIVE
The incidence of embolic events and of cerebral malperfusion in aortic dissection type A (AADA) must be viewed in the context of the existence of a number of possible cannulation techniques. Since femoral cannulation is thought to be associated with a higher risk of perfusion of the false lumen and retrograde embolization, techniques establishing antegrade flow may provide a better option. We describe herein our experience with ascending aortic cannulation in this special patient population.


METHODS
Between November 1999 and February 2006, 122 patients underwent operation for AADA with arterial access via the dissected ascending aorta. The aorta was cannulated at the site of the minimal distances of the dissected layers. Double purse-string sutures were used to support the cannula. Pressure monitoring in both radial arteries as well as bilateral cerebral oxygen saturation measurement helped to identify malperfusion after establishment of cardiopulmonary bypass. Aortic arch as well as aortic root surgery was performed, as dictated by the pathology. Selective antegrade cerebral perfusion and moderate hypothermia were used for brain and body protection.


RESULTS
Malperfusion occurred in three patients (2.5%). Hospital mortality was 15% for the entire cohort (18 patients). Permanent neurological dysfunction was detected in 15 patients (12%), whereas temporary neurological dysfunction occurred in 21 (17%). Total arch replacement was performed in 31 patients (25%).


CONCLUSIONS
Direct cannulation of the ascending aorta is an easy and safe method in patients with AADA. This technique, which also avoids retrograde flow in the downstream aorta, is an alternative to time-consuming axillary artery access.
Khaladj
Nawid
N
Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Khaladj.Nawid@mh-hannover.de
Shrestha
Malakh
M
Peterss
Sven
S
Strueber
Martin
M
Karck
Matthias
M
Pichlmaier
Maximilian
M
Haverich
Axel
A
Hagl
Christian
C
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D017548:Echocardiography, Transesophageal; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult