The combination of central aortic cannulation and no clamping technique in acute type a aortic dissection – results of 90 patients

Objective: Femoral artery cannulation is the customary cannulation site in acute type a-aortic dissection (AADA) with the risk for retrograde embolisation and malperfusion. Axillary artery cannulation becomes increasingly accepted by cardiac surgeons. Cannulation of the ascending aorta or the aortic arch is the routine approach for all cardiac surgeons, so why not in AADA? Methods: From 1997 until 2007 a total of 90 patients with AADA were operated under emergency conditions (62 men, 28 women, mean age 66.31 (32–85y)), 85 hemiarch repair and 5 total arch replacement were performed. Cannulation site was the ascending aorta (30%)or the aortic arch (70%). Under hypothermia (28 degrees) perfusion was stopped, the aorta was transsected and antegrade perfusion of all supraaortic vessels was established. Tear oriented repair of the aortic pathology was completed and after implantation and cannulation of the prosthesis the perfusion was re-established. Proximal aortic pathology was repaired during rewarming. Results: No conversion to cannulation to another artery was necessary. No malperfusion-incident was observed. Mortality rate (30 days and in-hospital) was 7.7%. Neurological deficits occured in 6.6%. Reexploration for bleeding was 4.4%. Blood loss was 783ml (mean, range 210–3500ml). Intraoperative transfusion rate was 0.4 units (range 0–10). Mean operation time was 232min (range 180–520), perfusion time was 147min (range 90–420). Conclusion: The combination of quick and easy cannulation of the ascending aorta, no-aortic clamping, antegrade perfusion of supraaortic vessels in hypothermic arrest can be performed with low mortality and morbidity in AADA.