title: Central cannulation by Seldinger technique: a reliable method in ascending aorta and aortic arch replacement.
abstract: BACKGROUND
  Extensive type A aortic dissections that involve peripheral great vessels can complicate the choice of a cannulation site for cardiopulmonary bypass. We started to employ direct cannulation of the true lumen on the concavity of the aortic arch by Seldinger technique and evaluated the efficacy of this access technique as an alternative arterial inflow target in aortic surgery.
  
  
  METHODS
  Twenty-four consecutive patients (mean age: 59±14 years) underwent type A aortic dissection repair using selective antegrade cerebral perfusion. Direct aortic cannulation was used in 14 cases, subclavian access in 6 patients, and femoral entry in 4 patients. Perioperative factors were evaluated to identify the reliability and eventual benefits of direct cannulation method at the aortic arch.
  
  
  RESULTS
  There were no operative deaths and cumulative 30-day mortality rate was 25% (6). Permanent neurological deficits were not observed; in 1 patient transient changes occurred (4%). Time to reach circulatory arrest was the shortest in the direct access group, with mean 27±11 (CI: 20.6-33.3) min vs. 43±22 (28.0-78.0) min (p=0.058) and 32±8 (23.6-40.4) min (p=0.34) by femoral cannulation and subclavian entry, respectively. Direct arch cannulation resulted in the best renal function in the first 72 h after surgery and similar characteristics were observed in lactic acid levels.
  
  
  CONCLUSIONS
  Ultrasound-guided direct cannulation on the concavity of the aortic arch using a Seldinger technique is a reliable method in dissection repairs. Prompt antegrade perfusion provides not only cerebral but also peripheral organ and tissue protection, which is an advantage in this high-risk group of patients.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Göbölös
authors.affiliation: Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ugocsai
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Maik
authors.initials: M
authors.lastname: Foltan
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Thrum
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Miskolczi
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
authors.forename: Pietro G
authors.initials: PG
authors.lastname: Malvindi
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: di Gregorio
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pousios
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
authors.forename: Manoraj
authors.initials: M
authors.lastname: Navaratnarajah
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Southampton NHS Trust, Southampton, United Kingdom.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Ohri
mesh_terms: D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002404:Catheterization; D003404:Creatinine / Q000378:metabolism; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care
chemical_list: D019344:Lactic Acid; D003404:Creatinine