Central aortic canulation in acute type A dissection and the use of selective antegrade perfusion provides superior neurological outcome

Objective: Recent advance in surgical technique facilitates more aggressive approaches for thoracic aortic diseases even in type A acute aortic dissection (AAAD) at lower temperatures. We investigated the outcomes of our strategy of central aortic cannulation, open distal anastomosis with tear oriented repair using antegrade perfusion and moderate hypothermia. Methods: A review of 130 patients who underwent aortic surgery for AAAD were analyzed pro-and retrospectively. A tear ortiented repair and central aortic cannulation was used in all cases. Selective antegrade perfusion was performed in moderate hypothermia. Results: Direct aortic cannulation was used in all cases and resulted in no adverse events. The antegrade perfusion was performed in all cases with selective perfusion of the right and left carotid artery and the left subclavian artery in 89% of the cases, among those 130 patients (100% of the cases) underwent an open distal anastomosis. Median age of the patients was 66.3 years (ranging from 26 to 89 years) with 65% being male. Performed operations were modified valve-sparing aortic root repairs (82%), and aortic root replacement with a stentless aortic valves (8%). Hemiarch replacement was added in 73.5%. The lowest temperature was 28.4 degrees C +/-1.3 degrees C. There were 10 deaths (mortality 7.6%). A total of 6 patients (4.6%) had major neurologic complications. Conclusions: Open distal anastomosis at the time of AAAD can be safely performed with central aortic cannulation and moderate hypothermia using antegrade perfusion of the carotid arteries and the left subclavian artery.