Femoral Cannulation is Safe for Type A Dissection Repair

Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience

“…Reportedly, both deep and moderate levels of hypothermia during the period of circulatory arrest have been used successfully (14)(15)(16)(17)22). Different cannulation strategies have been advocated (19,21,(23)(24)(25)(26)(27). Early application of the crossclamp during the cooling period has been reported (7,23), as has a clampless technique (15)(16)(17)(18)(19).…”

“…Overall operative mortality reported by North American centers varies from 5% to 17% (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) and may improve after protocol-based management is implemented and a thoracic aortic team is assembled (30,34). Mortality associated specifically with iatrogenic acute type A dissection has been recently reported as 27% after open surgical repair and up to 33-50% after TEVAR (6)(7)(8).…”

“…Different cannulation strategies have been advocated (19,21,(23)(24)(25)(26)(27). Early application of the crossclamp during the cooling period has been reported (7,23), as has a clampless technique (15)(16)(17)(18)(19). Operative details from North American cardiac surgery centers are shown in Table 1.…”

“…Major aortic surgery centers have described various extents of surgical repair with hemiarch (i.e., proximal arch) or total arch replacement and different adjuncts for brain protection [antegrade or retrograde cerebral perfusion (RCP)] (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Most North American centers (13)(14)(15)(16)(17)(18)(19)23) tend to favor ascending aorta and hemiarch replacement, with more extensive arch replacement in cases in which the arch is dilated more than 4.5-5 cm or the tear involves the aortic arch. Reportedly, both deep and moderate levels of hypothermia during the period of circulatory arrest have been used successfully (14)(15)(16)(17)22).…”

Proteção cerebral: sítios de canulação arterial e vias de perfusão do cérebro

“…Fusco et al [16], in 2004, reviewed 79 patients surgically treated for Stanford type-A acute aortic dissection, where CPB was established by femoral access. In this series, only two (2.5%) patients had unsatisfactory retrograde flow with the necessity to change the site of arterial cannulation.…”