Key result
Direct innominate arterial cannulation using a pediatric arterial cannula during total arch replacement for acute type A aortic dissection resulted in a perioperative mortality rate of 3.4% and a stroke rate of 6.9%.
Why the study?
To evaluate the safety of direct innominate arterial cannulation using a pediatric arterial cannula to establish selective antegrade cerebral perfusion during total arch replacement for acute Stanford type A aortic dissection.
Does direct innominate arterial cannulation using a pediatric arterial cannula provide safe brain protection in patients with acute type A aortic dissection undergoing total arch replacement?
Observational (n=29)
No
Does direct innominate arterial cannulation using a pediatric arterial cannula provide safe brain protection in patients with acute type A aortic dissection undergoing total arch replacement?
Direct innominate artery cannulation using a pediatric arterial cannula is a safe and effective technique for antegrade cerebral perfusion during total arch replacement for acute type A aortic dissection.
Low event rates support feasibility of direct innominate cannulation; leaves open need for larger prospective validation in acute type A dissection.
BACKGROUND: This study aimed to investigate the safety of direct innominate arterial (IA) cannulation using a pediatric arterial cannula to establish selective antegrade cerebral perfusion (ACP) during total arch replacement (TAR) for acute Stanford type A aortic dissection (ATAAD). METHODS: This retrospective study included patients with ATAAD who underwent TAR with the frozen elephant trunk (FET) technique between October 2020 and November 2021. Patients treated with direct IA cannulation using a pediatric arterial cannula for selective anterograde cerebral perfusion were included in the study. RESULTS: Of the 29 patients, 24 (82.8%) were male. The average age was 50.9 ± 9.47 years. Proximal repair included aortic root plasty (27 patients, [93.1%]) and Bentall surgery (2 patients, [6.9%]). Perioperative mortality and stroke rates were 3.4% and 6.9%, respectively. The mean lowest core temperature was 23.8 ± 0.74 °C and the mean ACP time was 25 ± 6.4 min. The aortic cross-clamp and cardiopulmonary bypass times were 141 ± 28 and 202 ± 29 min, respectively. There were no cases of IA injuries. CONCLUSION: Direct IA cannulation using a pediatric arterial cannula is a simple, safe, and effective technique for establishing ACP during TAR with the FET technique for ATAAD and can avoid the potential complications of axillary artery cannulation.
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Kong et al. (2022) conducted an observational in Acute Stanford type A aortic dissection (ATAAD) (n=29). Direct innominate arterial (IA) cannulation using a pediatric arterial cannula was evaluated on Perioperative mortality. Direct innominate arterial cannulation using a pediatric arterial cannula during total arch replacement for acute type A aortic dissection resulted in a perioperative mortality rate of 3.4% and a stroke rate of 6.9%.
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