title: The role of transapical cannulation in the operative management of acute aortic dissection.
abstract: OBJECTIVE
  The aim of the study was to investigate the usefulness of transapical cannulation as the routine cannulation site in patients with acute aortic dissection and to compare it with other cannulation methods.
  
  
  METHODS
  Between January 2010 and December 2013, emergency surgery was performed in 111 consecutive patients with acute type A aortic dissection. Patients were divided into two groups: transapical cannulation group and other cannulation sites group (including femoral and axillary artery cannulation). Pre-, intra- and postoperative data were compared between these two groups of patients.
  
  
  RESULTS
  Transapical cannulation was the most frequent cannulation site (78 patients, 70.3%), the femoral artery was selected in 24 patients (21.6%) and the axillary artery in 9 patients (8.1%). The mortality rate in the transapical group was 16.7% and 18.2% when other cannulation sites were chosen (p=0.85). No difference in postoperative stroke rate (6.4% vs 9.1%, p=0.62, transapical vs other cannulation sites group, respectively), myocardial infarction (6.4% vs 6.1%, p=0.94) and postoperative acute renal insufficiency incidence (9% vs 6.1%, p=0.61) was found.
  
  
  CONCLUSIONS
  Routine transapical cannulation in patients with acute type A aortic dissection is a fast and safe way to establish cardiopulmonary bypass. There is no difference in major operative outcomes after transapical cannulation when compared to the other cannulation sites.
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University of Belgrade, Belgrade, Serbia.
authors.forename: B P
authors.initials: BP
authors.lastname: Djukanovic
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University of Belgrade, Belgrade, Serbia.
authors.forename: S
authors.initials: S
authors.lastname: Micovic
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University of Belgrade, Belgrade, Serbia.
authors.forename: M S
authors.initials: MS
authors.lastname: Peric
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University of Belgrade, Belgrade, Serbia.
authors.forename: P S
authors.initials: PS
authors.lastname: Milojevic
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University of Belgrade, Belgrade, Serbia.
authors.forename: M V
authors.initials: MV
authors.lastname: Cirkovic
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University of Belgrade, Belgrade, Serbia.
authors.forename: M
authors.initials: M
authors.lastname: Boricic
authors.affiliation: Department of Cardiac Surgery, Dedinje Cardiovascular Institute, University of Belgrade, Belgrade, Serbia petarvuk@eunet.rs.
authors.forename: P M
authors.initials: PM
authors.lastname: Vukovic
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001019:Aortic Rupture / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality; D015996:Survival Rate
keywords: aortic dissection; aortic surgery; cannulation technique; cardiopulmonary bypass; transapical cannulation