Direct Cannulation of Ascending Aorta versus Standard Femoral Artery Cannulation in Acute Aortic Dissection Type A

Authors

  • Vassil Gegouskov Department of Cardiac Surgery, St. Anna University Hospital, Sofia, Bulgaria
  • Georgi Manchev Department of Cardiac Surgery, St. Anna University Hospital, Sofia, Bulgaria
  • Vladimir Danov Department of Cardiac Surgery, Medical University, Pleven, Bulgaria
  • Georgi Stoitsev Department of Cardiac Surgery, St. Anna University Hospital, Sofia, Bulgaria
  • Sergey Iliev Department of Propedeutics of Surgical Diseases, Medical University, Pleven, Bulgaria

DOI:

https://doi.org/10.1532/hsf.1956

Keywords:

aortic surgery, acute aortic dissection type A, direct cannulation, circulatory arrest, cerebral perfusion

Abstract

Background: During surgery for ascending aortic dissection, the dissected ascending aorta itself has traditionally been rejected as a cannulation option. The purpose of this study is to prove that direct cannulation of the ascending aorta in patients operated for acute aortic dissection type A (AADA) is at least as effective and safe as classic femoral cannulation.

Methods and Results: Between September 2008 and January 2015, we operated on 117 patients with AADA through median sternotomy. Cannulation was accomplished in
32 cases (27%) through the femoral artery (group A), and in 85 patients (73%) through the dissected ascending aorta (group B). Moderate hypothermic circulatory arrest with bilateral antegrade cerebral perfusion was used in 108 patients (92%). The mean time of circulatory arrest was 17 minutes (range: 9-52 minutes). The 30-day mortality rate was 22% (7 patients) in group A, and 18% (15 patients) in group B
(P = not significant). Temporary neurologic dysfunction (TND) including postoperative confusion, delirium, or agitation occurred in four patients (13%) in group A, and four patients (5%) in group B (P = not significant). The incidence of permanent neurologic dysfunction (stroke) was 9%
(3 patients) in group A and 3% (3 patients) in group B.

Conclusions: The direct cannulation of the ascending aorta is a safe alternative for patients with AADA, offering the opportunity for antegrade cerebral perfusion. It is easy to perform, reliable, and associated with acceptable early results.

References

Conzelmann L, Kayhan N, Mehlhorn U et al. 2009. Reevaluation of direct true lumen cannulation in surgery for acute type a aortic dissection. Ann Thorac Surg 87:1182-6.

Conzelmann L, Weigang E, Mehlhorn U et al. 2016. Mortality in patients with acute aortic dissection type a: analysis of pre- and intraoperative risk factors from the german registry for acute aortic dissection type A (GERAADA). Eur J Cardiothorac Surg 49:e44-e52.

Etz CD, von Aspern K, da Rocha E Silva J, et al. 2014. Impact of perfusion strategy on outcome after repair for acute type a aortic dissection. Ann Thorac Surg 97:78-85.

Flege JB, Aberg T. 2001 Transventricular aortic cannulation for repair of aortic dissection. Ann Thorac Surg 72:955–6.

Frederick J, Yang E, Trubelja A et al. 2013. Ascending aortic cannulation in acute type a dissection repair. Ann Thorac Surg 95:1808-11.

Fusco DS, Shaw RK, Tranquilli M et al. 2004. Femoral cannulation is safe for type a dissection repair. Ann ThoracSurg 78:1285-9.

Gobolos L, Ugocsal P, Foltan M et al. 2014. Central cannulation by seldinger technique: a reliable method in type a aortic dissection repairs. Med Sci Monit 20: 2386-93.

Hagl C, Khaladj N, Peterss S et al. 2004. Hypothermic circulatory arrest with and without cold selective antegrade cerebral perfusion: impact on neurological recovery and tissue metabolism in an acute porcine model. Eur J Cardiothorac Surg 26:73-80.

Jakob H, Tsagakis K, Szabo A et al. 2007. Rapid and safe direct cannulation of the true lumen of the ascending aorta in acute type a aortic dissection. J Thorac Cardiovasc Surg 134:244-5.

Kamiya H, Hagl C, Kropivnitskaya I et al. 2007. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg 133: 501-9.

Kamiya H, Kallenbach K, Halmer D et al. 2009. Comparison of ascending aorta versus femoral artery cannulation for acute aortic dissection type a. Circulation. 120 [suppl 1]:282-6.

Kamiya H, Klima U, Hagl C et al. 2006. Cerebral microembolization during antegrade selective cerebral perfusion. Ann Thorac Surg 81:519-21.

Khaladj N, Peterss S, Oetjen P et al. 2006. Hypothermic circulatory arrest with moderate, deep or profound hypothermic selective antegrade cerebral perfusion: which temperature provides best brain protection? Eur J Cardiothorac Surg 30:492-8.

Khaladj N, Shrestha M, Meck S et al. 2008. Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: A risk factor analysis for adverse outcome in 501 patients. J Thorac Cardiovasc Surg 135:908-14.

Khaladj N, Shrestha M, Peterss S et al. 2008. Ascending aortic cannulation in acute aortic dissection type a: the Hannover experience. Eur J Cardiothorac Surg 34:792-7.

Khaladj N, Shrestha M, Peterss S et al. 2008. Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience. Eur J Cardiothorac Surg. 34:792-6.

Klotz S, Bucsky B, Richardt D et al. 2016. Is the outcome in acute aortic dissection type a influenced by femoral versus central cannulation? Ann Cardiothorac Surg 5:310-16.

Krüger T, Conzelmann LO, Bonser RS, et al. 2012. Acute aortic dissection type a. Br J Surg 99:1331-44.

Luciani N, Anselmi A, Glieca F et al. 2012. Femoral cannulation with long arterial cannula in aortic dissection. Ann Thorac Surg 93:e45-7.

Mehta RH, Suzuki T, Hagan PG et al. 2002. Predicting death in patients with acute type a aortic dissection. behalf of the international registry of acute aortic dissection (IRAD) investigators. Circulation 105:200-6.

Merkkola P, Tulla H, Ronkainen A et al. 2006. Incomplete circle of willis and right axillary artery perfusion. Ann Thorac Surg 82:74-9.

Minatoya K, Karck M, Szpakowski E et al. 2003. Ascending aortic cannulation for stanford type a acute aortic dissection: another option. J Thorac Cardiovasc Surg 125:952-3.

Papanchev V, Stoinova V, Aleksandrov A et al. 2013. The role of willis circle variations during unilateral selective cerebral perfusion: a study of 500 circles. Eur J Cardiothorac Surg 44:743-53.

Reece TB, Tribble CG, Smith RL et al. 2007. Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg 133:428-34.

Robicsek F, Guarino RL. 1985. Compressing of the true lumen by retrograde perfusion during repair of aortic dissection. J Cardiovasc Surg 26:36-40.

Shimokawa T, Takanashi S, Ozawa N et al. 2008. Management of intraoperative malperfusion syndrome using femoral artery cannulation for repair of acute type a aortic dissection. Ann Thorac Surg 85:1619-24.

Sinclair MC, Singer RL, Manley NJ et al. 2003. Cannulation of the axillary artery for cardiopulmonary bypass: safeguards and pitfalls. Ann Thorac Surg. 75:931-34.

Suzuki T, Asai T, Matsubayashi K et al. 2010. Safety and efficacy of central cannulation through ascending aorta for type a aortic dissection. Interact Cardiovasc Thorac Surg 11:34-37.

Published

2018-04-30

How to Cite

Gegouskov, V., Manchev, G., Danov, V., Stoitsev, G., & Iliev, S. (2018). Direct Cannulation of Ascending Aorta versus Standard Femoral Artery Cannulation in Acute Aortic Dissection Type A. The Heart Surgery Forum, 21(3), E139-E144. https://doi.org/10.1532/hsf.1956

Issue

Section

Article