Cannulation of the innominate artery during surgery of the thoracic aorta: our experience in 55 patients

Eusanio, Marco Di; Ciano, Michele; Labriola, Giuseppe; Lionetti, Giosuè; Eusanio, Giuseppe Di

doi:10.1016/j.ejcts.2007.03.050

Cited by 54 publications

(35 citation statements)

References 13 publications

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“…Carotid artery cannulation, performed by Urbanski and co-workers in 100 patients so far, including 27 with AADA, seems to be another elegant method, but also carries the risk of brain malperfusion as described above [9]. The experience with innominate artery cannulation by Di Eusanio and co-workers includes 55 patients with only two in AADA [24].…”

Section: Discussionmentioning

confidence: 96%

Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience☆☆☆

Khaladj

Shrestha

Peterß

et al. 2008

European Journal of Cardio-Thoracic Surgery

112

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Section: Discussionmentioning

confidence: 96%

Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience☆☆☆

Khaladj

Shrestha

Peterß

et al. 2008

European Journal of Cardio-Thoracic Surgery

112

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“…In small series, combined RAxA/ScA and FemA cannulation have been used to prevent malperfusion with encouraging outcomes (194). Carotid and innominate artery cannulation to avoid malperfusion have also been used by some authors (195)(196)(197)198), and occasionally unique perfusion solutions have been generated to combat intraoperative malperfusion (199).…”

Section: The Aims and Objectives Of Ataad Surgerymentioning

confidence: 98%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

216

175

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Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

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“…98,99) Despite a high technical success rate of over 90%, one should pay attention to an entry to the left atrium, or conversion of route may be needed due to mal-perfusion or aortic regurgitation. Rarely, the innominate artery 100) or carotid artery 101) is used for the perfusion route. However, these elaborate attempts do not necessarily ensure successful restoration of the true lumen.…”

Section: Perfusion Routementioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

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Cannulation of the innominate artery during surgery of the thoracic aorta: our experience in 55 patients

Cited by 54 publications

References 13 publications

Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience☆☆☆

Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience☆☆☆

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

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