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

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Axel Haverich Christian Hagl Permission Requests Google Scholar Articles by Khaladj, N. Articles by Hagl, C. PubMed Articles by Khaladj, N. Articles by Hagl, C. Related Collections Great vessels

Letters to the Editor

Reply to Abunasra et al. The exciting question of cannulation site in acute aortic dissection type A

Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany

Received 7 March 2009; accepted 11 March 2009.

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

Key Words: Acute aortic dissection type A • Cannulation site • Aortic cross-clamping

We thank Mr Abunasra and co-workers for their comments and interest in our work [1].

Again, their remarks show that cannulation site is an important issue and still under controversial discussion.

In our opinion, the technique of direct ascending aortic cannulation can be performed with an acceptable failure rate compared to other techniques. Nevertheless, we congratulate Mr Abunasra and co-workers for their excellent results with the transapical approach.

To our knowledge, the technique of transapical cannulation in patients with acute aortic dissections type A (AADA) was initially described by Professor Hans Borst from Hannover in cases of malperfusion [2]. Prior to this publication this technique has been used in porcelain aortas [3]. One of the major drawbacks of this elegant technique is the prolonged cardiopulmonary bypass (CPB) and operation time due to the fact that aortic cross-clamping is not possible during cooling. Since the group from Leicester avoids cross-clamping of the dissected aorta as a matter of principle, this may not have a real impact [1]. We and others believe that saving CPB-time, which is significantly associated with an increased mortality in patients undergoing hypothermic circulatory arrest, is of utmost importance [4,5]. On the other hand, we understand the critical remarks of colleagues who may prefer other techniques than direct cannulation in AADA. Nevertheless, we are looking forward to the publication of Mr Abunasra's experience with the transapical approach.

References

1. Abunasra H, Alexiou C, Sosnowski A. Arterial cannulation for acute type A aortic dissection. Eur J Cardiothorac Surg 2009;36:227-228.[Free Full Text]
2. Borst HG, Laas J, Heinemann M. Type A aortic dissection: diagnosis and management of malperfusion phenomena. Semin Thorac Cardiovasc Surg 1991;3:238-241.[Medline]
3. Golding LA. New cannulation technique for the severely calcified ascending aorta. J Thorac Cardiovasc Surg 1985;90:626-627.[Abstract]
4. Khaladj N, Shrestha M, Meck S, Peterss S, Kamiya H, Kallenbach K, Winterhalter M, Hoy L, Haverich A, Hagl C. Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: a risk factor analysis for adverse outcome in 501 patients. J Thorac Cardiovasc Surg 2008;135:908-914.[Abstract/Free Full Text]
5. Immer FF, Aydin NB, Lutolf M, Krahenbuhl ES, Stalder M, Englberger L, Eckstein FS, Schmidli J, Carrel TP. Does aortic crossclamping during the cooling phase affect the early clinical outcome of acute type A aortic dissection?. J Thorac Cardiovasc Surg 2008;136:1536-1540.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Axel Haverich Christian Hagl Permission Requests Google Scholar Articles by Khaladj, N. Articles by Hagl, C. PubMed Articles by Khaladj, N. Articles by Hagl, C. Related Collections Great vessels