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.
