Direct Cannulation of Ascending Aorta versus Standard Femoral Artery Cannulation in Acute Aortic Dissection Type A

Autor: Sergey Iliev, Georgi J Stoitsev, Vassil Gegouskov, Georgi Manchev, Vladimir Danov
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
Catheters
medicine.medical_treatment
Aorta
Thoracic
Femoral artery
Catheterization
Young Adult
Postoperative Complications
medicine.artery
Ascending aorta
Ascending Aorta
medicine
Humans
Thoracic aorta
Cerebral perfusion pressure
Bulgaria
Direct Cannulation
Stroke
Aged
Retrospective Studies
Aged
80 and over
Aortic dissection
Aortic Aneurysm
Thoracic
business.industry
Acute Aortic Dissection
Incidence
Equipment Design
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Surgery
Femoral Artery
Survival Rate
Aortic Dissection
Treatment Outcome
Median sternotomy
Acute Disease
Circulatory system
cardiovascular system
Female
Tomography
X-Ray Computed
Cardiology and Cardiovascular Medicine
business
Vascular Surgical Procedures
Echocardiography
Transesophageal
Follow-Up Studies
Popis: Background: During surgery for ascending aortic dissection, the dissected ascending aorta itself has traditionally been rejected as a cannulation option. The purpose of this study is to prove that direct cannulation of the ascending aorta in patients operated for acute aortic dissection type A (AADA) is at least as effective and safe as classic femoral cannulation.Methods and Results: Between September 2008 and January 2015, we operated on 117 patients with AADA through median sternotomy. Cannulation was accomplished in 32 cases (27%) through the femoral artery (group A), and in 85 patients (73%) through the dissected ascending aorta (group B). Moderate hypothermic circulatory arrest with bilateral antegrade cerebral perfusion was used in 108 patients (92%). The mean time of circulatory arrest was 17 minutes (range: 9-52 minutes). The 30-day mortality rate was 22% (7 patients) in group A, and 18% (15 patients) in group B (P = not significant). Temporary neurologic dysfunction (TND) including postoperative confusion, delirium, or agitation occurred in four patients (13%) in group A, and four patients (5%) in group B (P = not significant). The incidence of permanent neurologic dysfunction (stroke) was 9% (3 patients) in group A and 3% (3 patients) in group B.Conclusions: The direct cannulation of the ascending aorta is a safe alternative for patients with AADA, offering the opportunity for antegrade cerebral perfusion. It is easy to perform, reliable, and associated with acceptable early results.
Databáze: OpenAIRE
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