Safe direct aortic cannulation via seldinger technique in acute aortic dissections

Introduction: Optimal arterial cannulation for acute type A aortic dissection is debated controversially. Direct aortic cannulation is not widely accepted by surgeons.

Methods: In a retrospective analysis, direct aortic cannulation via seldinger technique was analyzed in 16 consecutive patients (age 25–79 years) presenting with typ A dissection. The correct position of the aortic cannula in the true lumen was verified by transesophagial echocardiography and by direct vision at incision of the aortic arch. Six patients had dissection of the supraaortic arteries), in 2 cases axillary cannulation (failed), and in 6 patients the membrane was detached completely circular in the ascending aorta and the arch.

Results: In all 16 patients direct aortic cannulation via seldinger technique was performed quickly and successfully. Cannulation site was the ascending aorta (6/16), the truncus brachiocephalicus (2/16), and the aortic arch (8/16). No complications were observed. In addition, in 6 cases presenting with circular detachment of the membrane, the true lumen was penetrated by crossing the false lumen first. This was most easily done in the region of the ligamentum arteriosum. All patients underwent aortic arch replacements in deep hypothermic circulatory arrest (50.2±18.1min) and antegrade cerebral perfusion. Thirty-day mortality was 12.5%.

Conclusions: Improvement of direct aortic cannulation by seldinger technique proofed to be a safe strategy in aortic dissection. It allowed for safe cannulation of the true lumen even in cases not accessible by conventional cannulation techniques and represents a valuable and rapid alternative to axillary cannulation.