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Transapical aortic cannulation via left lateral thoracotomy for descending thoracic and thoracoabdominal aortic
Tomonobu Abe1, Toshiaki Ito, Masatoshi Sunada
1Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Aichi, Japan. tomonobu_abe@chukyo-hosp.jp
Insights
Transapical aortic cannulation offers a viable surgical option for chronic type B aortic dissection. This technique provides stable circulation and improved aortic manipulation during complex thoracic aortic procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Surgery
Background:
- Chronic type B aortic dissection presents complex surgical challenges.
- Traditional cannulation methods may have limitations in specific aortic repair scenarios.
Observation:
- Two patients with chronic type B aortic dissection underwent surgical repair.
- Total cardiopulmonary bypass (CPB) was established using transapical arterial cannulation of the ascending aorta and left femoral artery.
- Aortic arch cross-clamping was performed between the left carotid and left subclavian arteries.
Findings:
- Successful surgical repair was achieved in both patients without complications.
- Procedures involved replacement of the descending thoracic aorta, with one case including intercostal artery reconstruction.
- Transapical aortic cannulation facilitated stable circulation and precise aortic manipulation.
Implications:
- Transapical aortic cannulation is a valuable alternative for descending thoracic and thoracoabdominal aortic surgery.
- This technique may enhance circulatory stability, allow gentler aortic handling with nonpulsatile flow, and offer greater temperature control flexibility.
Abstract:
Two patients underwent surgery for a chronic type B dissection using a total cardiopulmonary bypass (CPB) with transapical arterial cannulation. At surgery, a total CPB was established by cannulating the left femoral artery and the ascending aorta via the ventricular apex. The patients were cooled to 30 degrees C. The proximal anastomosis was done after cross-clamping the aortic arch between the left carotid artery and the left subclavian artery in both cases. In the first case, the entire descending thoracic aorta was replaced, and two pairs of intercostal arteries were reconstructed. The other patient underwent replacement of the proximal descending thoracic aorta. Neither patient experienced any complications. Transapical aortic cannulation is a useful option during descending thoracic and thoracoabdominal aortic surgery. It can provide more stable circulation during the cross-clamping, more gentle manipulation of the aorta by nonpulsatile flow, and more liberty in temperature control.
