[Retrograde aortic dissection during cardiopulmonary bypass a case report successfully treated by contralateral...

Retrograde aortic dissection is the most critical complication associated with femoral perfusion. It may be related to the trauma of femoral cannulation per se or to the jet of retrograde perfusion. We report the successful repair of a retrograde aortic dissection by composite graft replacement of the dissected ascending aorta using contralateral femoral cannulation. A 66-year-old man presented with aortic regurgitation due to annuloaortic ectasia. At the operation, the right common femoral artery was cannulated, and cardiopulmonary bypass was initiated. Within a few minutes after beginning the bypass, we recognized a retrograde dissection showing a tense bluish bulge in the ascending aorta. Bleeding was detected from the dissected aortic root beside the right coronary ostium. The bypass was interrupted, and contralateral femoral cannulation was performed immediately to re-establish the bypass. Composite graft replacement of the aortic root and ascending aorta was successfully performed under hypothermic circulatory arrest using additional retrograde cerebral perfusion. Pathological findings of the aortic wall revealed cystic medionecrosis. When a retrograde aortic dissection occurs, it is essential to establish antegrade flow. If it is impossible to cannulate at the ascending aorta for any reason, a contralateral femoral cannulation can be used successfully to re-establish the cardiopulmonary bypass because of the easy access.