Transatrial left ventricular cannulation for arterial return to manage retrograde type A dissection in minimally invasive mitral valve surgery

Introduction: Aortic dissection is a rare complication in minimally invasive mitral valve procedure. We describe our new transatrial cannulation technique of the left ventricle for arterial return in acute retrograde type A dissection during minimally invasive mitral valve surgery. Backround: A Seventy-three years old female was admitted with severe mitral valve regurgitation for minimally invasive valve surgery. After cannulating the femoral vessels and initiation of cardiopulmonary bypass malperfusion occured after a few minutes as indicated by a drop of blood pressure. TEE showed a retrograde type A aortic dissection. We decided to use our standard technique for arterial return in acute type A aortic dissection. Via the right anterolateral approach we brought in an arterial cannula into the left atrium via the right upper pulmonary vein. The cannula was positioned in the left ventricle passing the mitral valve controlled by transoesophageal echocardiography. Cardiopulmonary bypass again could be established with satisfying periphere perfusion. After conversion to median sternotomy we replaced the ascending aorta in hypothermic cardiopulmonary arrest followed by mitral valve repair. No focal neurological disorders occured and the patient was extubated on the first postoperative day. Discussion: We here describe transatrial cannulation of the left ventricle as an alternative cannulation site for arterial return for type A aortic dissection during minimally invasive valve surgery. Transatrial cannulation proved to be a fast and effective way for establishing extracorporal circulation. Thus, we suggest to re-evaluate the use of this technique for arterial cannulation in type A dissection.