Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations

Wada, Shinichi; Yamamoto, Shin; Honda, Jiro; Hiramoto, Akinori; Wada, Hideichi; Hosoda, Yasuhiro

doi:10.1016/j.jtcvs.2006.04.016

Cited by 93 publications

(56 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Left ventricular apex is also used: transapical approach. 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.…”

Section: Perfusion Routementioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

View full text Add to dashboard Cite

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...

show abstract

Section: Perfusion Routementioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

View full text Add to dashboard Cite

show abstract

“…There was no case in which conversion case to other arterial cannulation sites, and in all 138 patients sufficient flow in cardiopulmonary bypass could be achieved. 9) This is the attractive outcome. However, there is a critical complication, bleeding at apex.…”

Section: Discussionmentioning

confidence: 92%

Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Fukunaga

Saji

Kanemitsu

et al. 2015

ATCS

View full text Add to dashboard Cite

IntroductionType A acute aortic dissection (AAD) is still a devastating disease, which mortality rate following medical managements reaches to 50% within the first 48 h. 1) The mortality rate associated with AAD after surgery has decreased, but it reached to roughly 20% worldwide. 2) In Japan, hospital mortality rate after an emergency surgery for AAD was 9.2% in 2010. 3) Antegrade cerebral perfusion (ACP) is one of the techniques for cerebral protection during proximal aortic surgery. This technique has been applied to a repair of AAD and effective circulation management could be achieved by Comas et al. 2) Controversy that which arterial cannulation site is optimal in a repair of AAD exists. 4,5) Femoral artery is the usual cannulation site for cardiopulmonary bypass in a repair of AAD, 6) on the other hand, the retrograde perfusion via the femoral artery causes retrograde thromboembolism from atheromatous debris in the thoracic and was performed in 34 patients. Mean age was 64.5 ± 13.7 years of age. Preoperative shock status was in three due to cardiac tamponade. Organ malperfusion occurred in 11 patients preoperatively. Mean follow-up period was 9.6 ± 8.4 months and follow-up rate was 100%. Results: Hospital mortality rate was 8.8%. No newly required hemodialysis and new onset of temporary or permanent neurologic deficits were present in survivors. There were no statistically significant differences of mortality rate, new onset of permanent or temporary neurologic deficits and distal organ dysfunction between ACP duration <60 min and ≥60 min. The 12-month survival was 84.4% ± 6.4%. And, freedom from aorta-related events at 12 and 18 months were 100% ± 0.0% and 88.9% ± 10.5%, respectively. Conclusions: The duration of ACP via right axillary artery does not affect early outcomes following a repair of AAD.

show abstract

“…19) In 2006, Wada and colleagues reported the safety and usefulness of transapical aortic cannulation for establishing CPB for repairing an AAAD. 20) In their report, the surgical mortality rate was high (18.8%) due to the severe preoperative condition of the patients. Almost all of the deaths were caused by organ ischemia from malperfusion that had been present before the operation.…”

Section: Discussionmentioning

confidence: 92%

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Suenaga

Sato

Fumoto

et al. 2015

ATCS

View full text Add to dashboard Cite

consecutive patients with AAAD were underwent the ascending aortic replacement at Nagasaki Kouseikai Hospital. These patients were divided into two groups according to the cannulation site, FA cannulation (n = 34) and TAA cannulation (n = 46). Early and mid-term outcomes were compared between two groups. Result: Preoperative patient characteristics were almost comparable between groups. The time from skin incision to starting cardiopulmonary bypass (CPB) was significantly shorter in the TAA group (45 ± 16 vs 23 ± 5.1 min; P <0.001). There were no significant differences in post-operative cerebral infarction in two groups (17% versus 11%; P = NS). The operative mortality rate was 8.8% in FA group and 4.3% in TAA group (P = NS). During follow up (mean, 6.8 years), survival at 3 years and 5 years was 77.4% and 71.9% in TAA group and 76.3% and 73.8% in FA group, respectively. Conclusion: The postoperative morbidity and mortality between the two groups were almost the same. TAA cannulation for acute Type A aortic dissection is faster, easy and safe with acceptable early and mid-term outcome.

show abstract

Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations

Cited by 93 publications

References 11 publications

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Contact Info

Product

Resources

About