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Central cannulation is safe in acute aortic dissection repair
T Brett Reece1, Curtis G Tribble, Robert L Smith
1University of Virginia, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Charlottesville, Va, USA. tbr5q@virginia.edu
Insights
Cannulating the dissected aorta for ascending aortic dissection repair is safe. Direct aortic cannulation showed lower cardiac events and mortality compared to peripheral cannulation in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Dissection Repair
Background:
- The optimal cannulation site for ascending aortic dissection repair is debated.
- Concerns exist regarding the safety and efficacy of cannulating the dissected aorta.
Purpose of the Study:
- To investigate the safety and outcomes of cannulating the dissected aorta versus peripheral cannulation in patients undergoing ascending aortic dissection repair.
- To test the hypothesis that central cannulation is safe with acceptable complication and mortality rates.
Main Methods:
- Retrospective review of 70 patients with acute ascending aortic dissections (1996-2005).
- Comparison of central (dissected aorta) cannulation (n=24) versus peripheral (femoral/axillary artery) cannulation (n=46).
- Analysis of comorbidities, mortality, complications, hospital stay, and disposition.
Main Results:
- No significant differences in bypass, crossclamp, or circulatory arrest times between groups.
- Similar hospital mortality and postoperative complications (including stroke) between central and peripheral cannulation groups.
- Peripheral cannulation was associated with significantly more cardiac events (15% vs 0%) and higher mortality (19.5% vs 4.2%) compared to central cannulation.
Conclusions:
- Direct cannulation of the dissected aorta is a safe alternative to peripheral cannulation for ascending aortic dissection repair.
- This technique allows for tailored cannulation strategies based on patient anatomy and characteristics to optimize outcomes.
- Cannulating the dissected aorta can be safely employed in high-risk populations.
Objective:
The site of cannulation for the repair of ascending aortic dissection remains controversial. It is not clear whether cannulation of the dissected vessel is safe or even preferred. We hypothesized that cannulation of the dissected aorta could be done safely with acceptable complication and mortality rates in this high-risk population.
Methods:
The charts of repairs of acute ascending aortic dissections (n = 70) from 1996 to 2005 were reviewed. Cannulation was accomplished in 24 patients via the dissected aorta (central) and in 46 patients through cannulation of the femoral or axillary artery (peripheral). All were converted to sidearm cannulation of the graft for reperfusion. Groups were compared on the basis of comorbidities in addition to mortality, complications, hospital stays and final disposition.
Results:
The groups were comparable on the basis of age and preoperative comorbidities. Similarly, there were no differences in bypass time, crossclamp time, or hypothermic circulatory arrest time between groups. Hospital mortality and postoperative complications, including stroke, were similar between groups, but the peripheral group experienced more cardiac events (peripheral 15% vs central 0%; P < .05) and higher mortality than the central group (peripheral 19.5% vs central 4.2%; P < .05).
Conclusions:
Direct cannulation of the dissected aorta was safe compared with peripheral cannulation in these patients. Inasmuch as these data demonstrate that cannulation of the dissected ascending aorta is safe, this technique can be used to tailor the cannulation approach to specific anatomic and patient characteristics that might optimize postoperative outcomes in this disease entity.
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