Retrograde Aortic Dissection During Cardiopulmonary Bypass: “Nonoperative” Management

Carey, Joseph S.; Skow, James R.; Scott, C.

doi:10.1016/s0003-4975(10)64570-5

Cited by 23 publications

(10 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Applebaum et al (1976) specifically excluded patients with iatrogenic dissections when reporting their experience of surgical treatment of dissecting aneurysms of the aorta, and it seems to us that these represent a subgroup at particularly high risk. This has also been the experience of other workers (Elliot and Roe, 1965;Kay et al, 1966), although Carey et al (1977) recorded six survivals out of seven cases in which aortic dissection appeared during cardiopulmonary bypass; in no case was the ascending aorta repaired or replaced.…”

Section: Discussionsupporting

confidence: 75%

Surgery of the ascending aorta: five years' experience at a regional cardiac centre.

Reasbeck¹,

Monro²,

Ross³

et al. 1979

Thorax

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 75%

Surgery of the ascending aorta: five years' experience at a regional cardiac centre.

Reasbeck¹,

Monro²,

Ross³

et al. 1979

Thorax

View full text Add to dashboard Cite

show abstract

“…One of the two deaths in our series of six patients occurred when the dissection went unrecognized until late in the course of bypass while perfusion through the femoral artery was continued. The literature confirms the impoftance of prompt, appropriate treatment of a dissection (Benedict et al, 1974;Bilgutay et al, 1976;Carey et al, 1977;Dongaonkar, 1966;Elliott and Roe, 1965;Gosalbez et al, 1979;Jones et al, 1960;Kay et al, 1966;Lam et al, 1974;Lefrak and Howell, 1972;Matar and Ross, 1967;Pappas and Starzl, 1970;van der Woude and Itocovicci, 1965;Vathayanon et al, 1967;Williams and Johnson, 1964). Eighteen ofa total of 53 patients survived a retrograde aortic dissection.…”

Section: Treatmentmentioning

confidence: 74%

“…Of 53 patients described in the literature. 35 (66%) died (Benedict et al .• 1974;Bilgutay et al .• 1976;Carey et al .• 1977;Dongaonkar. 1966;Elliott and Roe.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Retrograde aortic dissection during cardiopulmonary bypass

Eugene

Aronow

Stemmer

1981

Clinical Cardiology

View full text Add to dashboard Cite

Summary: Femoral artery perfusion for cardiopulmonary bypass is still employed for reoperation, procedures involving the thoracic aorta, and partial bypass in critical patients. Retrograde aortic dissection is the most significant complication of femoral perfusion. The reported incidence is from 0.6% to 14% with a mortality of 66%. Most of the deaths occurred in patients in whom the dissection was not recognized, or in whom the dissection was recognized but not treated appropriately. Our experience with retrograde dissection totals six patients of 640 (0.9%) in whom femoral inflow was used. Four of the six patients survived the dissection. Sudden increase in extracorporeal line pressure shortly after beginning cardiopulmonary bypass associated with decreased venous return, dampened radial arterial pressure, and the abrupt appearance of a bluish, bulging ascending aorta establishes the diagnosis. Survival is enhanced if cardiopulmonary bypass is promptly discontinued, aortic cannulation established, and bypass reinstituted with the induction of profound hypothermia. Circulatory arrest may then be employed to repair the false passage. In this series the proposed operation was completed in all six patients.

show abstract

“…Although the idea of cannulating ascending aorta of type A aortic dissection was reported about three decades ago [10,11], direct cannulation to ascending aorta for type A aortic dissection has only been performed reluctantly as a bail-out procedure through transection of the aorta in case of retrograde malperfusion [12]. Because of poor outcome, direct cannulation to the ascending aorta has been avoided by surgeons for type A dissections, and has not been reported positively [13].…”

Section: Discussionmentioning

confidence: 99%

Ascending aorta cannulation in acute type A aortic dissection

Inoue¹,

Ueda²,

Taguchi³

et al. 2007

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Objective: Antegrade perfusion for type A acute aortic dissection prevents malperfusion and retrograde cerebral embolism during cardiopulmonary bypass. Prompt establishment of antegrade perfusion via ascending aorta may improve the surgical results of type A dissections, especially in the situations of hemodynamic instability. Thus, we evaluated the efficacy of use of the dissected ascending aorta as an alternative arterial inflow. Methods: Between 2002 and 2006, 32 patients underwent prosthetic graft replacement of the ascending aorta or hemiarch for acute type A aortic dissection. The ascending aorta was routinely cannulated, in addition to the femoral artery, with a heparin-coating flexible cannula for arterial inflow, using Seldinger technique, and by epiaortic ultrasonographic guidance (n = 6). Antegrade systemic perfusion via ascending aorta was performed. Results: Ascending aorta cannulation was safely performed in all cases. There was no malperfusion or thromboembolism due to ascending aorta cannulation. Cardiopulmonary bypass was established within 30 min after skin incision. There was one in-hospital death due to duodenal bleeding (1/32 = 3.1%), two cases of cerebral infarction (2/32 = 6.3%), and one case of pulmonary embolism. Twenty-nine patients (29/32 = 90.6%) were discharged in New York Heart Association class I and have been followed up uneventfully for a mean of 17 months. Conclusions: Antegrade perfusion via the ascending aorta was successfully performed with low mortality and morbidity. With ultrasound-guided Seldinger technique, ascending aorta cannulation has a potential to be a simple and safe option that enables rapid establishment of antegrade systemic perfusion in patients with acute type A aortic dissection. #

show abstract

Retrograde Aortic Dissection During Cardiopulmonary Bypass: “Nonoperative” Management

Cited by 23 publications

References 8 publications

Surgery of the ascending aorta: five years' experience at a regional cardiac centre.

Surgery of the ascending aorta: five years' experience at a regional cardiac centre.

Retrograde aortic dissection during cardiopulmonary bypass

Ascending aorta cannulation in acute type A aortic dissection

Contact Info

Product

Resources

About