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Efficacy and pitfalls of transapical cannulation for the repair of acute type A aortic dissection.

Abstract

BACKGROUND
Selection of a cannulation site for the repair of acute type A aortic dissection remains controversial. Several cannulation sites have been introduced, but each is associated with a risk of adverse complications. Transapical cannulation is a simple procedure to restore antegrade blood flow during ECC. However the efficacy of this procedure is unknown.
METHODS
Among 400 patients undergoing surgical repair of acute type A dissection at Sakakibara Heart Institute between 2003 and 2010, transapical cannulation was performed in 52 patients, and these patients were included in this study. Transapical cannulation was selected as the initial cannulation site in 44 patients and as conversion from femoral cannulation in 8 patients.
RESULTS
There were 4 in-hospital mortalities (mortality rate, 7.7%) and 5 patients had strokes (stroke rate, 9.6%). Transapical cannulation was successful in 47 patients (90.4%). Conversion of the cannulation site was necessary in 5 patients: Malperfusion on initiation of ECC was observed in 4 patients and emergence of aortic regurgitation was observed in 1 patient. The cannula was moved to another artery for correction in these patients. There was no mortality in patients undergoing conversion of the cannulation site.
CONCLUSIONS
Transapical cannulation is considered an effective option for the repair of acute type A aortic dissection. Transapical cannulation cannot eliminate the risk of intraoperative malperfusion, and therefore careful assessment with intraoperative monitoring is necessary.

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  • Publisher Full Text

    • Authors

    Matsushita A, Manabe S, Tabata M, Fukui T, Shimokawa T, Takanashi S

    Institution

    Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.

    Source

    The Annals of thoracic surgery 93:6 2012 Jun pg 1905-9

    MeSH

    Acute Disease
    Aged
    Algorithms
    Aneurysm, Dissecting
    Angioplasty
    Aorta
    Aorta, Thoracic
    Aortic Aneurysm, Thoracic
    Blood Vessel Prosthesis Implantation
    Catheterization
    Female
    Heart Catheterization
    Hospital Mortality
    Humans
    Male
    Middle Aged
    Postoperative Complications
    Stroke
    Surgical Procedures, Minimally Invasive
    Treatment Outcome

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22483651