title: A selection of cases of direct cannulation in surgery for type A dissection.
abstract: BACKGROUND
  We use antegrade cannulation, circulatory arrest, and selective antegrade cerebral perfusion in patients with acute aortic dissection. While blood is generally supplied via the ascending aorta, this route can be difficult, depending on the features of dissection and the form of the true lumen. In such cases, we incise the ascending aorta and insert the cannula directly into the true lumen of the ascending aorta to secure the blood supply.
  
  
  METHODS
  Between April 2005 and April 2012, direct true lumen cannulation of the ascending aorta was performed in 12 patients; 5 had total arch replacement, and 7 had ascending aorta and hemiarch replacement.
  
  
  RESULTS
  Total arch replacement involved circulatory arrest for 62 ± 16 min, aortic crossclamping for 174 ± 13 min, cardiopulmonary bypass for 211 ± 11 min, and a minimal rectal temperature of 28.4 ± 1.8. Ascending aorta and hemiarch replacement involved arrest of the circulation for 40 ± 9 min, aortic crossclamping for 111 ± 29 min, cardiopulmonary bypass for 131 ± 34 min, and a minimal rectal temperature of 27.8 ± 0.9. One patient died from cerebral infarction during hospitalization.
  
  
  CONCLUSIONS
  In these cases, direct true lumen cannulation of the ascending aorta was effective.
authors.affiliation: Department of Cardiovascular Surgery, Ebina General Hospital, Kanagawa, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Nie
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Hari
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Ohara
authors.forename: Kagami
authors.initials: K
authors.lastname: Miyaji
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D002404:Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002544:Cerebral Infarction / Q000209:etiology / Q000401:mortality; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aneurysm; aortic aneurysm; blood vessel prosthesis implantation; cardiopulmonary bypass; dissecting