title: Efficacy and pitfalls of transapical cannulation for the repair of acute type A aortic dissection.
abstract: BACKGROUND
  Selection of a cannulation site for the repair of acute type A aortic dissection remains controversial. Several cannulation sites have been introduced, but each is associated with a risk of adverse complications. Transapical cannulation is a simple procedure to restore antegrade blood flow during ECC. However the efficacy of this procedure is unknown.
  
  
  METHODS
  Among 400 patients undergoing surgical repair of acute type A dissection at Sakakibara Heart Institute between 2003 and 2010, transapical cannulation was performed in 52 patients, and these patients were included in this study. Transapical cannulation was selected as the initial cannulation site in 44 patients and as conversion from femoral cannulation in 8 patients.
  
  
  RESULTS
  There were 4 in-hospital mortalities (mortality rate, 7.7%) and 5 patients had strokes (stroke rate, 9.6%). Transapical cannulation was successful in 47 patients (90.4%). Conversion of the cannulation site was necessary in 5 patients: Malperfusion on initiation of ECC was observed in 4 patients and emergence of aortic regurgitation was observed in 1 patient. The cannula was moved to another artery for correction in these patients. There was no mortality in patients undergoing conversion of the cannulation site.
  
  
  CONCLUSIONS
  Transapical cannulation is considered an effective option for the repair of acute type A aortic dissection. Transapical cannulation cannot eliminate the risk of intraoperative malperfusion, and therefore careful assessment with intraoperative monitoring is necessary.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Matsushita
authors.forename: Susumu
authors.initials: S
authors.lastname: Manabe
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000465:Algorithms; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017130:Angioplasty / Q000379:methods*; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome