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Central aortic cannulation for Stanford type a aortic dissection with the use of three-dimensional and
Derek R Brinster1, Dan W Parrish, Kenneth Sadler Meyers
1Virginia Commonwealth University Medical Center, Richmond, Virginia.
Insights
Central aortic cannulation for acute type A aortic dissection (STAADs) reduces cardiopulmonary bypass (CPB) time and procedure complexity. This retrospective study supports its use, though further trials are needed.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Dissection Repair
Background:
- Debate exists regarding optimal arterial cannulation for cardiopulmonary bypass (CPB) in acute type A aortic dissection (STAADs).
- Central aortic cannulation is proposed to reduce CPB time, operative duration, and procedural complexity.
Purpose of the Study:
- To evaluate central aortic cannulation as a viable and preferable method for CPB in STAAD repair.
- To compare outcomes between central aortic cannulation and other cannulation methods.
Main Methods:
- Retrospective review of 34 consecutive STAAD repairs (October 2006 - January 2014).
- Analysis of cannulation method, CPB time, cross-clamp time, circulatory arrest time, mortality, and complications.
- Comparison with a control group undergoing non-aortic cannulation.
Main Results:
- Distal aortic arch cannulation was most common and associated with lowest relative mortality.
- 30-day mortality was 17.6%; common complications included arrhythmia, acute renal injury, and delayed extubation.
- Cerebrovascular accidents occurred in 8.8% of patients.
- Aortic cannulation demonstrated statistically significant reductions in bypass and cardiac arrest times.
Conclusions:
- Central aortic cannulation is a viable CPB option for STAAD repair.
- Further prospective, randomized trials are required to establish central aortic cannulation over peripheral techniques.
Background:
There is still significant disagreement among surgeons about the best method for arterial cannulation to institute cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection (STAADs). This study aimed to provide support for central aortic cannulation as a viable and preferable option, as it reduces time to institute CPB, operative times, and decreases the complexity of the procedure.
Methods:
This study is a retrospective review of 34 patients who underwent STAAD repairs consecutively between October 2006 and January 2014. The sample was analyzed for method of cannulation, CPB time, cross-clamp time, circulatory arrest time, mortality, and complication rate. Statistical analysis was performed to compare a control group of patients who underwent nonaortic cannulation.
Results:
The most common method of cannulation was the distal aortic arch, which also produced the lowest relative mortality. The 30-day mortality was found to be 17.6%. Arrhythmia, acute renal injury, and failure to extubate within 48 hours were the most frequent complications, and cerebrovascular accidents occurred in three patients (8.8%). Statistically significant differences in bypass and cardiac arrest times favored aortic cannulation.
Conclusions:
This study supports the notion that central aortic cannulation is a viable option for CPB in STAAD repair, but further prospective, randomized trials are necessary for the procedure to replace peripheral cannulation techniques.
