Direct and Transapical Central Cannulation for Acute Type A Aortic Dissection

Abstract

Objective: The choice of cannulation site for the treatment of acute Stanford type A aortic dissection is much debated. We believe that central cannulation is quick to perform, easy to use, and safe to manage acute type A aortic dissection. Materials and Methods: We retrospectively investigated 26 cases of acute aortic dissection performed using two different central cannulation methods between April 2011 and March 2012. Direct ascending aortic cannulation was performed using the Seldinger technique in 20 patients, and transapical ascending aortic cannulation was performed in six patients in whom puncture was difficult. Results: Patients were 21-86 years old (mean age, 67 years). The surgical techniques used to treat aortic dissection were hemiarch repair in 21 patients and total arch replacement in 5 patients. The mean length of surgery was 393 min. One death (3.8%) was attributed to intestinal ischemia. Conclusion: During surgery for acute aortic dissection, central cannulation using either transapical or direct puncture can be performed quickly and safely, and satisfactory short-term outcomes can be obtained. Because acute aortic dissection can present with various conditions, there is no single perfect surgical or cannulation method; therefore, the choice of surgical procedure should be individualized for each patient.

Ascending aortic cannulation in acute type A aortic dissection: a frightening but lifesaving procedure

“…It has been reported a few times since [11][12][13][14][15]. The Seldinger technique under epiaortic colour Doppler echography and transoesophageal echocardiography are used routinely in this cannulation procedure [16]. We believe that, because of the possible expanding aortic dissection that was affecting both axillary and femoral arteries, it clearly was mandatory to cannula the ascending aorta.…”

Alternative Aortic Access: Translumbar, Transapical, Subclavian, Conduit, and Transvenous Access to the Aorta

“…24 Central cannulation (either transapical or direct aortic puncture) may offer reduced complications related to malperfusion or embolism. Direct puncture requires median sternotomy.…”

The cannulation strategy in surgery for acute type A dissection

“…Generally speaking, axillary cannulation is more time-consuming than femoral artery cannulation [23, 26]. Central aortic cannulation by the Seldinger technique and transapical cannulation can be completed quickly [27, 28]. …”

“…A 1-cm incision is then made at the apex of the left ventricle without a purse-string suture, and a cannula with curved stylet is inserted through the apex and across the aortic valve until positioned in the ascending aorta under transesophageal echocardiographic guidance [49]. It took only short period of time for CPB to be established [27]. Good results have been reported with this technique [50, 51].…”