scholarly journals Comparison of Ascending Aorta Versus Femoral Artery Cannulation for Acute Aortic Dissection Type A

Circulation ◽  
2009 ◽  
Vol 120 (11_suppl_1) ◽  
pp. S282-S286 ◽  
Author(s):  
H. Kamiya ◽  
K. Kallenbach ◽  
D. Halmer ◽  
M. Ozsoz ◽  
K. Ilg ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Femoral Artery ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Artery Cannulation ◽  
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 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.

ARCH Replacement in Acute Aortic Dissection Type a in Normothermia

2001 ◽  
Vol 71 (3) ◽  
pp. 282-286
Author(s):  
Ovidiu Stiru ◽  
Roxana Carmen Geana ◽  
Adrian Tulin ◽  
Raluca Gabriela Ioan ◽  
Victor Pavel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Ct Scan ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Ascending Aorta ◽  
Descending Aorta ◽  
The Right ◽  
Aortic Dissection Type A

The purpose of this case presentation is to present a simplified surgical technique when in a patient with acute aortic dissection type A (AAD), aortic arch, and ascending aorta is completely replaced without circulatory arrest. A 67-year old male was presented in our institution with severe chest and back pain at 12 h after the onset of the symptoms. Imaging studies by 3D contrast-enhanced thoracic computed tomography (CT-scan) and transesophageal echocardiography (TEE) revealed ascending aortic dissection towards the aortic arch, which was extending in the proximal descending aorta. We practiced emergency median sternotomy and established cardiopulmonary bypass (CBP) between the right atrium and the right femoral artery with successive cross-clamping of the ascending and descending aorta below the origin of the left subclavian artery (LSA). In normothermic condition without circulatory arrest and with antegrade cerebral perfusion, we replaced the ascending aorta and aortic arch with a four branched Dacron graft. Patient evolution was uneventful, and he was discharged, after fourteen days from the hospital. At a one-year follow-up, 3D CT-scan showed no residual dissection with a well-circulated lumen of the supra-aortic arteries. Using the described surgical approach, CPB was not interrupted, the brain was protected, and hypothermia was no used. This approach made these surgical procedures shorter, and known complications of hypothermia and circulatory arrest are avoided.Acute aortic dissection aortic type A, total arch replacement, normothermia

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