Key result
Cannulation approach in type A aortic dissection should depend on individual patient characteristics, presentation, and true lumen anatomy, with axillary and central strategies showing satisfactory results.
The choice of cannulation strategy in type A aortic dissection surgery should be tailored to individual patient anatomy and presentation to optimize true lumen perfusion.
Individualized cannulation may optimize outcomes in type A dissection; leaves open the need for randomized trials to guide selection.
Type A aortic dissection most often requires emergent surgery to prevent malperfusion, stroke, and/or rupture of aorta. To achieve the structural goals of the operation, the conduct of the surgery is targeted from it inception at restoring true lumen flow. In this regard, institution of cardiopulmonary bypass and circulation management is key to allow adequate systemic flow, perfusion of brain and visceral organs and comprehensive systemic cooling to achieve circulatory arrest when needed. Different strategies have been used to establish adequate true lumen perfusion with varying success rates, with the most common still being femoral cannulation. More recently axillary and central cannulation strategies have shown satisfactory results by allowing more reliable true lumen flow. Cannulation approach should, therefore, depend on individual patient characteristics, presentation, and true lumen anatomy.
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Saran et al. (2021) conducted a review in Type A aortic dissection. Cannulation strategies (femoral, axillary, central) was evaluated. Cannulation approach in type A aortic dissection should depend on individual patient characteristics, presentation, and true lumen anatomy, with axillary and central strategies showing satisfactory results.
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