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DOI: 10.1055/s-2008-1037844
Direct true lumen cannulation in surgery for acute Typ-A aortic dissection – a promising approach
Aims: The optimal arterial cannulation in acute Typ-A aortic dissection is controversial. We retrospectively investigated direct true lumen cannulation as an alternative to standard cannulation procedures.
Materials: From 04/2004 to 08/2007, 29 patients, mean age 63.2 (range 35–88) years, 20 male and 9 female, underwent emergency operation for Typ-A-Dissection with direct true lumen cannulation. Following venous drainage into the venous reservoir, the ascending aorta was completely transsected in the region between sinutubular junction and truncus brachiocephalicus. After visual and digital identification of the true lumen, the arterial cannula was directly inserted into the true lumen and secured with a ligature.
Results: Mean aortic cross clamp time was 77.4 (range 11–131) minutes. For distal anastomosis, circulatory arrest was necessary in 11 patients for 19.2 (range 1–41) minutes. Organ protection was performed under hypothermia of 27.6°C (range 17–35.7). All patients survived. There were no technical problems with this new method. Median intubation time was 26.8 (range 8.3–1700) hours. Median intensive care unit stay was 4.0 (range 2–42) days. Two patients had a prolonged postoperative course and required permanent ventilation. Hemofiltration was necessary in three patients; one was already in a dialysis program. There were no gastrointestinal problems. Permanent neurological disorders appeared in four patients: two patients had severe cerebral hypoxia and two had reduced vigilance. Four patients had temporary hemiplegia under good regression.
Conclusion: Direct true lumen cannulation is a new promissing surgical alternative for emergency operation in Typ-A aortic dissection with excellent results, even in elderly patients.