Direct ascending aortic cannulation and selective antegrade cerebral perfusion in acute aortic dissection type A

2007 ◽  
Vol 55 (S 1) ◽  
Author(s):  
N Khaladj ◽  
C Hagl ◽  
S Peterss ◽  
A Martens ◽  
K Kallenbach ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Cerebral Perfusion ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Aortic Cannulation ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion ◽  
Aortic Dissection Type A

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

2021 ◽  
Vol 104 (4) ◽  
pp. 604-609
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Axillary Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Ultrasound Guided ◽  
True Lumen ◽  
Artery Cannulation ◽  
Aortic Cannulation ◽  
Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p<0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

scholarly journals The use of innominate artery cannulation for antegrade cerebral perfusion in aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Eden C. Payabyab ◽  
Jonathan M. Hemli ◽  
Allan Mattia ◽  
Alex Kremers ◽  
Sohrab K. Vatsia ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Cerebral Perfusion ◽  
Innominate Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Artery Cannulation ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

Abstract Background Direct cannulation of the innominate artery for selective antegrade cerebral perfusion has been shown to be safe in elective proximal aortic reconstructions. We sought to evaluate the safety of this technique in acute aortic dissection. Methods A multi-institutional retrospective review was undertaken of patients who underwent proximal aortic reconstruction for Stanford type A dissection between 2006 and 2016. Those patients who had direct innominate artery cannulation for selective antegrade cerebral perfusion were selected for analysis. Results Seventy-five patients underwent innominate artery cannulation for ACP for Stanford Type A Dissections. Isolated replacement of the ascending aorta was performed in 36 patients (48.0%), concomitant aortic root replacement was required in 35 patients (46.7%), of whom 7 had a valve-sparing aortic root replacement, ascending aorta and arch replacement was required in 4 patients (5%). Other procedures included frozen elephant trunk (n = 11 (14.7%)), coronary artery bypass grafting (n = 20 (26.7%)), and peripheral arterial bypass (n = 4 (5.3%)). Mean hypothermic circulatory arrest time was 19 ± 13 min. Thirty-day mortality was 14.7% (n = 11). Perioperative stroke occurred in 7 patients (9.3%). Conclusions This study is the first comprehensive review of direct innominate artery cannulation through median sternotomy for selective antegrade cerebral perfusion in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and cerebral protection for delivering selective antegrade cerebral perfusion in these cases.

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

2008 ◽  
Vol 34 (4) ◽  
pp. 792-796 ◽  
Author(s):  
Nawid Khaladj ◽  
Malakh Shrestha ◽  
Sven Peterss ◽  
Martin Strueber ◽  
Matthias Karck ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Aortic Cannulation ◽  
Aortic Dissection Type A

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

2018 ◽  
Vol 21 (3) ◽  
pp. 139
Author(s):  
Vassil Gegouskov ◽  
Georgi Manchev ◽  
Vladimir Danov ◽  
Georgi Stoitsev ◽  
Sergey Iliev
Keyword(s):  
Aortic Dissection ◽  
Femoral Artery ◽  
Cerebral Perfusion ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Ascending Aorta ◽  
Group A ◽  
Group B ◽  
Antegrade Cerebral Perfusion ◽  
Aortic Dissection Type A

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.

scholarly journals The Use of Innominate Artery Cannulation for Antegrade Cerebral Perfusion in Aortic Dissection

2020 ◽  
Author(s):  
Eden C Payabyab ◽  
Jonathan M. Hemli ◽  
Allan Mattia ◽  
Alex Kremers ◽  
Sohrab K. Vatsia ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Cerebral Perfusion ◽  
Innominate Artery ◽  
Type A ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Artery Cannulation ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

Abstract Background: Direct cannulation of the innominate artery for selective antegrade cerebral perfusion has been shown to be safe in elective proximal aortic reconstructions. We sought to evaluate the safety of this technique in acute aortic dissection. Methods: A multi-institutional retrospective review was undertaken of patients who underwent proximal aortic reconstruction for Stanford type A dissection between 2006 and 2016. Those patients who had direct innominate artery cannulation for selective antegrade cerebral perfusion were selected for analysis. Results: Seventy-five patients underwent innominate artery cannulation for ACP for Stanford Type A Dissections. Isolated replacement of the ascending aorta was performed in 36 patients (48.0%), concomitant aortic root replacement was required in 35 patients (46.7%), of whom 7 had a valve-sparing aortic root replacement, ascending aorta and arch replacement was required in 4 patients (5%). Other procedures included frozen elephant trunk (n = 11 (14.7%)), coronary artery bypass grafting (n = 20 (26.7%)), and peripheral arterial bypass (n = 4 (5.3%)). Mean hypothermic circulatory arrest time was 19 ± 13 minutes. Thirty-day mortality was 14.7% (n = 11). Perioperative stroke occurred in 7 patients (9.3%).Conclusions: This study is the first comprehensive review of direct innominate artery cannulation through median sternotomy for selective antegrade cerebral perfusion in aortic dissection. Our experience suggests that this strategy is a safe and effective technique compared to other reported methods of cannulation and cerebral protection for delivering selective antegrade cerebral perfusion in these cases.

Abstract 754: Ascending Aortic vs. Femoral Cannulation for Acute Aortic Dissection Type A

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hiroyuki Kamiya ◽  
Dominique Halmer ◽  
Merve Oezsoez ◽  
Kathrin Ilg ◽  
Artur Lichtenberg ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Operation Time ◽  
Type A ◽  
Patient Characteristics ◽  
Study Cohort ◽  
Aortic Cannulation ◽  
Aortic Dissection Type A

Objectives: The site of cannulation for repair of ascending aortic dissection remains controversial. Here we present our experience with ascending aortic cannulation for acute aortic dissection type A (AADA). Methods: From 01/1988 to 09/2007, we operated on 242 patients for AADA. Medical records of 235 patients who received ascending aortic cannulation or femoral cannulation were retrospectively reviewed. Long term follow-up was complete in 97% of patients. Cannulation was accomplished in 82 patients through the ascending aorta and in 153 patients through the femoral artery. Results: There were no significant differences in preoperative characteristics between groups. Similarly, there were no differences in preoperative patient characteristics and intraoperative parameters including operation time (ascending 357±139 vs. peripheral 342±125 min.; p=0.40), bypass time (ascending 219±105 vs peripheral 206±96 min.; p=0.32), cross-clamp time (ascending 106±43 vs peripheral 106±51 min.; p=0.69), hypothermic circulatory arrest time (ascending 28±19 vs peripheral 27±23 min.; p=0.73), and percentage of total arch replacement (ascending 54.9% vs peripheral 55.7%; p=0.44). Hospital mortality was 12.2% in each group (p=0.98), and incidence of stroke was 4.9% in ascending group and 4.5% in peripheral group (p=0.86). During follow-up (mean 5.5 years), survival at 5 years and 10 years was 65% and 41% in ascending group and 64% and 46% in peripheral group, respectively (p=0.97). No persistent malperfusion by ECC was observed after aortic cannulation. Conclusions: Direct cannulation of the dissected aorta in patients with AADA was safe with acceptable results in our study cohort. The conventional femoral cannulation had no advantage on the direct cannulation strategy, and the avoidance of additional incision and possible peripheral vascular injury may favor the direct cannulation strategy.

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