Document Detail

Synchronized epiaortic two-dimensional and color Doppler echocardiographic guidance enables routine ascending aortic cannulation in type A acute aortic dissection.
MedLine Citation:
PMID:  21241859     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Preference for arterial inflow during surgery for type A acute aortic dissection remains controversial. Antegrade central perfusion prevents malperfusion and retrograde embolism, and the ascending aorta provides arterial access for rapid establishment of systemic perfusion, especially if there is hemodynamic instability. It has not been used routinely, however, because of the disruption caused to the aorta. We evaluated the safety and efficacy of routine cannulation of the dissected aorta for the repair of type A dissection.
METHODS: Surgical results were analyzed for 83 consecutive patients with type A acute aortic dissection between 2002 and 2009. They were treated surgically by prosthetic graft replacement under hypothermic circulatory arrest. The ascending aorta was routinely cannulated using the Seldinger technique with epiaortic echocardiographic guidance; antegrade systemic perfusion was evaluated by color Doppler ultrasound.
RESULTS: Systemic antegrade perfusion via the dissected ascending aorta was performed safely in all cases. There was no malperfusion or thromboembolism as a result of ascending aortic cannulation. Epiaortic 2-dimensional and color Doppler imaging provided real-time monitoring adequate for the placement and for proper systemic perfusion. There were 5 in-hospital deaths (5/83=6.0%) and 8 strokes (preoperative 6/83=7.2%, postoperative 2/83=2.4%). A total of 78 patients (78/83=94%) were discharged and have been followed up without major adverse cardiac events for a mean duration of 31.8 months.
CONCLUSIONS: Ascending aortic cannulation is a simple and safe technique that provides a rapid and reliable route of antegrade central systemic perfusion in type A aortic dissection.
Yoshito Inoue; Ryuichi Takahashi; Toshihiko Ueda; Ryohei Yozu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-18     Completed Date:  2011-02-17     Revised Date:  2011-08-31    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  354-60     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Department of Cardiovascular Surgery, Hiratsuka, City Hospital, Kanagawa, Japan.
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MeSH Terms
Acute Disease
Aneurysm, Dissecting / mortality,  physiopathology,  surgery*,  ultrasonography*
Aortic Aneurysm / mortality,  physiopathology,  surgery*,  ultrasonography*
Blood Vessel Prosthesis Implantation*
Catheterization, Peripheral* / adverse effects,  mortality
Heart Arrest, Induced
Hospital Mortality
Hypothermia, Induced
Middle Aged
Perfusion* / adverse effects,  mortality
Regional Blood Flow
Stroke / etiology
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Color*
Comment In:
J Thorac Cardiovasc Surg. 2011 Aug;142(2):479-80; author reply 480   [PMID:  21763885 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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