HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) On-line Video Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nawid Khaladj Malakh Shrestha Martin Strueber Matthias Karck Axel Haverich Christian Hagl Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Khaladj, N. Articles by Hagl, C. Search for Related Content PubMed Articles by Khaladj, N. Articles by Hagl, C. Related Collections Cerebral protection Extracorporeal circulation Great vessels

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

Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany

Received 18 November 2007; received in revised form 24 April 2008; accepted 9 May 2008.

^_* Corresponding author. Tel.: +49 511 532 6581; fax: +49 511 532 5404. (Email: Khaladj.Nawid{at}mh-hannover.de).

Objective: The incidence of embolic events and of cerebral malperfusion in aortic dissection type A (AADA) must be viewed in the context of the existence of a number of possible cannulation techniques. Since femoral cannulation is thought to be associated with a higher risk of perfusion of the false lumen and retrograde embolization, techniques establishing antegrade flow may provide a better option. We describe herein our experience with ascending aortic cannulation in this special patient population. Methods: Between November 1999 and February 2006, 122 patients underwent operation for AADA with arterial access via the dissected ascending aorta. The aorta was cannulated at the site of the minimal distances of the dissected layers. Double purse-string sutures were used to support the cannula. Pressure monitoring in both radial arteries as well as bilateral cerebral oxygen saturation measurement helped to identify malperfusion after establishment of cardiopulmonary bypass. Aortic arch as well as aortic root surgery was performed, as dictated by the pathology. Selective antegrade cerebral perfusion and moderate hypothermia were used for brain and body protection. Results: Malperfusion occurred in three patients (2.5%). Hospital mortality was 15% for the entire cohort (18 patients). Permanent neurological dysfunction was detected in 15 patients (12%), whereas temporary neurological dysfunction occurred in 21 (17%). Total arch replacement was performed in 31 patients (25%). Conclusion: Direct cannulation of the ascending aorta is an easy and safe method in patients with AADA. This technique, which also avoids retrograde flow in the downstream aorta, is an alternative to time-consuming axillary artery access.

Key Words: Acute aortic dissection • Arterial cannulation side • Aortic surgery

This article has been cited by other articles:

				H. Kamiya, K. Kallenbach, D. Halmer, M. Ozsoz, K. Ilg, A. Lichtenberg, and M. Karck Comparison of Ascending Aorta Versus Femoral Artery Cannulation for Acute Aortic Dissection Type A Circulation, September 15, 2009; 120(11_suppl_1): S282 - S286. [Abstract] [Full Text] [PDF]

				N. Khaladj, S. Peterss, A. Haverich, and C. Hagl Selective antegrade three-vessel cerebral perfusion: a technique to protect the brain and the lower body? Eur. J. Cardiothorac. Surg., August 1, 2009; 36(2): 425 - 426. [Full Text] [PDF]

				H. Abunasra, C. Alexiou, and A. Sosnowski Arterial cannulation for acute type A aortic dissection Eur. J. Cardiothorac. Surg., July 1, 2009; 36(1): 227 - 228. [Full Text] [PDF]

				M. I. Turina Editorial comment Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 796 - 797. [Full Text] [PDF]