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Updated: Jul 4, 2026
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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience
Nawid Khaladj1, Malakh Shrestha, Sven Peterss
1Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Khaladj.Nawid@mh-hannover.de
Summary
Direct ascending aortic cannulation is a safe and effective technique for aortic dissection type A (AADA) surgery, reducing malperfusion risks. This method offers an alternative to axillary artery access, improving patient outcomes in complex aortic procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic dissection type A (AADA) presents risks of embolic events and cerebral malperfusion.
- Femoral cannulation may increase the risk of false lumen perfusion and retrograde embolization.
- Antegrade flow techniques are explored as potentially safer alternatives.
Purpose of the Study:
- To evaluate the safety and efficacy of ascending aortic cannulation in patients with AADA.
- To compare outcomes with other cannulation strategies.
Main Methods:
- A retrospective review of 122 AADA patients undergoing ascending aortic cannulation (November 1999 - February 2006).
- Cannulation at the site of minimal dissected layer distance, supported by double purse-string sutures.
- Monitoring of radial artery pressure and bilateral cerebral oxygen saturation to detect malperfusion.
- Procedures included aortic arch and root surgery, with selective antegrade cerebral perfusion and moderate hypothermia.
Main Results:
- Low incidence of malperfusion (2.5%, 3 patients).
- Hospital mortality rate of 15% (18 patients).
- Permanent neurological dysfunction in 12% (15 patients) and temporary in 17% (21 patients).
- 25% (31 patients) underwent total arch replacement.
Conclusions:
- Direct ascending aortic cannulation is a straightforward and safe approach for AADA.
- This technique effectively avoids retrograde flow in the descending aorta.
- It serves as a viable alternative to more time-consuming axillary artery access methods.
