Central cannulation by Seldinger technique: a reliable method in ascending aorta and aortic arch replacement

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Access

Background:

• Extensive type A aortic dissections pose challenges for cardiopulmonary bypass cannulation site selection.
• Traditional cannulation sites can be compromised in complex aortic dissections.

Purpose of the Study:

• To evaluate the efficacy of direct cannulation of the true lumen in the aortic arch using the Seldinger technique.
• To assess this method as an alternative arterial inflow target in aortic surgery for type A dissections.

Main Methods:

• Twenty-four patients with type A aortic dissection underwent repair with selective antegrade cerebral perfusion.
• Direct aortic arch cannulation was compared with subclavian and femoral access in 14, 6, and 4 patients, respectively.
• Perioperative factors were analyzed to determine the reliability and benefits of direct arch cannulation.

Main Results:

• No operative deaths occurred; 30-day mortality was 25%.
• No permanent neurological deficits were observed; one patient had transient changes (4%).
• Direct arch cannulation achieved the shortest time to circulatory arrest and demonstrated superior renal function and lactate levels post-operatively.

Conclusions:

• Ultrasound-guided direct cannulation of the aortic arch via Seldinger technique is a reliable method for type A aortic dissection repair.
• This approach facilitates prompt antegrade perfusion, offering significant protection to cerebral and peripheral organs.
• Direct arch cannulation is an advantageous technique for high-risk patients undergoing aortic dissection surgery.