Aortic cannulation for type A dissection: guidance by transesophageal echocardiography

We describe an alternative technique for aortic arch cannulation that can be used during the repair of Stanford type A aortic dissection. In order to minimize the risk of complications and malperfusion associated with retrograde flow during cardiopulmonary bypass, we avoided femoral artery cannulation and used antegrade flow via a direct cannulation of the aortic arch in an area free of dissection. Transesophageal echocardiography is used peri-operatively to guide the cannulation of the true lumen in the distal aortic arch.