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DOI: 10.1055/s-0029-1246742
Transatrial cannulation for acute type A dissection
Introduction: An alternative technique of arterial cannulation in type a dissection was performed.
Background: A sixty-six years old patient was admitted with acute chest pain. Computertomography showed an type a dissection with supracoronary entry reaching to the aortic bifurcation involving both subclavian arteries.
After cannulating the femoral artery and initiation of cardiopulmonary bypass malperfusion occured as indicated by blood pressure drop. Antegrade perfusion via the ascending aorta was not possible due to the entry site. We decided to bring in a small arterial cannula into the left atrium via the right upper pulmonary vein as used in LV-venting. The cannula was positioned proximal to the mitral valve controlled by transoesophageal echocardiography. Cardiopulmonary bypass was successfully initiated with satisfying periphere perfusion. Opening the ascending aorta a complete circular dissection was found. Supracoronary replacement of the ascending aorta was performed in hypothermic arrest. The postoperative course was complicated by septic pneumonia. No focal neurological disorders occured and the patient was discharged after four weeks stay on the ICU.
Discussion: The optimal way of establishing extracorporal circulation in type a aortic dissection remains still controversial. The different sites of arterial cannulation are all associated with advantages and disadvantages as malperfusion or central embolisation.
We performed successfully an arterial access via the left atrium. Transatrial cannulation is an alternative cannulation site in acute type a dissection. It may offer a safe alternative technique in selected cases. To our knowledge this is the first report of transatrial cannulation in type a dissection.