title: Central aortic cannulation for Stanford type a aortic dissection with the use of three-dimensional and two-dimensional transesophageal echocardiography.
abstract: BACKGROUND
  There is still significant disagreement among surgeons about the best method for arterial cannulation to institute cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection (STAADs). This study aimed to provide support for central aortic cannulation as a viable and preferable option, as it reduces time to institute CPB, operative times, and decreases the complexity of the procedure.
  
  
  METHODS
  This study is a retrospective review of 34 patients who underwent STAAD repairs consecutively between October 2006 and January 2014. The sample was analyzed for method of cannulation, CPB time, cross-clamp time, circulatory arrest time, mortality, and complication rate. Statistical analysis was performed to compare a control group of patients who underwent nonaortic cannulation.
  
  
  RESULTS
  The most common method of cannulation was the distal aortic arch, which also produced the lowest relative mortality. The 30-day mortality was found to be 17.6%. Arrhythmia, acute renal injury, and failure to extubate within 48  hours were the most frequent complications, and cerebrovascular accidents occurred in three patients (8.8%). Statistically significant differences in bypass and cardiac arrest times favored aortic cannulation.
  
  
  CONCLUSIONS
  This study supports the notion that central aortic cannulation is a viable option for CPB in STAAD repair, but further prospective, randomized trials are necessary for the procedure to replace peripheral cannulation techniques.
authors: Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors: Derek R
authors: DR
authors: Brinster
authors: Dan W
authors: DW
authors: Parrish
authors: Kenneth Sadler
authors: KS
authors: Meyers
authors: Pingle
authors: P
authors: Reddy
authors: Vigneshwar
authors: V
authors: Kasirajan
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002404:Catheterization / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety; D025321:Surgery, Computer-Assisted; D013997:Time Factors