Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience☆☆☆

Abstract

Direct cannulation of the ascending aorta is an easy and safe method in patients with AADA. This technique, which also avoids retrograde flow in the downstream aorta, is an alternative to time-consuming axillary artery access.

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

“…Our early outcomes in the TAA group, 4.3% mortality and 11% stroke, are acceptable compared with other reports not only about FA cannulation, 25) and ascending cannulation, [15][16][17][18] but also with axillary cannulation, [8][9][10] in the treatment of AAAD. As described above, there are advantages and disadvantages to each cannulation technique.…”

“…13,14) Recently, direct cannulation into the dissected ascending aorta has been reported by several surgeons. [15][16][17][18] This technique can be performed rapidly without injury to the peripheral arteries, but there are concerns that it may increase the risks of rupture, extension of the dissection and malperfusion. TAA cannulation is an old technique that was initially described in the early 1970s.…”

Alternative cannulation techniques in surgical repair for acute type A aortic dissection

“…It provides an advantage of antegrade perfusion but has the risk of the false lumen cannulation, which might lead to aortic rupture, or malperfusion [11]. This cannulation technique includes direct cannulation of the dissected ascending aorta [12][13][14] or transapical cannulation of the ascending aorta [10]. This technique is not recommended as the first cannulation option.…”

“…They cannulated the ascending aorta at the site of the minimal distances of the dissected layers and used double purse-string sutures for cannula fixation. They showed that this technique is a safe option with malperfusion in 3 (2.5%) patients, aortic rupture in 1 (0.8%) patient, and hospital mortality in 18 (15%) patients [13].…”

“…Direct cannulation of the dissected ascending aorta in 122 patients with AAAD was presented by Hannover group [13]. In contrast to other groups, their technique includes direct approach to the the aorta (conventional cannulation) in a less dissected or nondissected area.…”