Safety and Efficacy of Ascending Aorta Cannulation during Repair of Acute Type A Aortic Dissection (PA29-04): “Presented at the 65th Annual Scientific Meeting of the Japanese Association for Thoracic Surgery”

OBJECTIVE:

Antegrade central perfusion for
acute Stanford type A aortic dissection prevents malperfusion and
retrograde cerebral embolism during cardiopulmonary bypass. Prompt
establishment of antegrade perfusion via the ascending aorta may improve
surgical results of type A dissections, especially in situations of
hemodynamic instability. Thus, we evaluated the safety and efficacy of
cannulation of the dissected ascending aorta in acute type A dissection.

METHODS:

We
reviewed the medical charts of patients undergoing repair of acute
ascending aortic dissection (n = 52) from April 2010 to April 2013.
Cannulation was accomplished in 29 patients via the ascending aorta
(central) and in 23 patients via the femoral or axillary artery
(peripheral). The ascending aorta was routinely cannulated using
Seldinger technique under epiaortic ultrasound guidance. Comorbidities,
mortality, complications, and durations of hospital stays were compared
for the groups.

RESULTS:

In all cases, routine
cannulation of the ascending aorta was safely performed with no
resultant malperfusion or thromboembolism. Mean operative duration,
cardiopulmonary bypass time, intubation time, and intensive care unit
stay were significantly shorter in the central group. Two patients
(6.8 %) in the central group died compared with four patients (17.3 %)
in the peripheral group (P = 0.005).

CONCLUSIONS:

Antegrade
central perfusion via the ascending aorta, a simple and safe technique
that enables rapid establishment of antegrade systemic perfusion, was as
safe as peripheral cannulation in patients with type A acute aortic
dissection.