Transapical Aortic Cannulation for Type A Acute Aortic Dissection

(Department of Cardiovascular Surgery, National Hospital Organization Nagano Hospital, Ueda, Japan and Department of Thoracic and Cardiovascular Surgery, Dokkyo University School of Medicine*, Tochigi, Japan)

Yoshiei Shimamura* Takahiro Takemura Masayuki Sakaguchi
Yasutoshi Tsuda Shizuko Iwasa Kouta Agematsu
The use of transapical aortic cannulation for arterial inflow during surgical repair of type A acute aortic dissection was evaluated. Thirty-six patients who underwent repair of type A aortic dissection were divided into 2 groups: those who underwent repair with transapical aortic cannulation (group A; 19 patients) and those who underwent repair with axillary and/or femoral artery cannulation (group C; 17 patients). Preoperative condition, estimated blood loss, transfusion requirements, and duration of the tube drainage and postoperative hospital stay did not differ in the 2 groups. Cannulations were successful in all patients, and none of the attempted inflow sites required moving to alternate sites in either group. The time to initiation of extracorporeal circulation (74.2}16.2min versus 88.8}12.5min, p0.005) and the extracorporeal circulation time (175.2}55.5min versus 216.6}58.1min, p0.036) was shorter in group A than in group C. However, the total operation time did not differ between the groups (309.3}112.5min in group A versus 363.4}130.9min in group C, p0.198). All patients survived the operation, and there were no complications directly related to transapical aortic cannulation. Postoperative stroke tended to be lower in group A than in group C (5.3% versus 29.4%; p0.081). There was 1 operative death in group A (5.3%) and 4 operative deaths in group C (23.5%) (p0.167). These data demonstrate that the use of transapical aortic cannulation yielded more favorable results than other cannulation techniques for induction of extracorporeal circulation and for minimization of extracorporeal circulation time and postoperative morbidity. We conclude that transapical aortic cannulation represents a safe, effective and less invasive means of providing arterial inflow during cardiopulmonary bypass for patients undergoing surgical correction of type A aortic dissection.
@Jpn. J. Cardiovasc. Surg. 34: 321-326 (2005)