Open direct cannulation of the true lumen under visual control of the ascending aorta in acute type A aortic dissection: a fast and safe alternative

Objective: Axillary cannulation is the arterial access of choice in acute type A aortic dissection. Hemodynamic instability and involvement of the innominate artery may require a faster alternative approach. We report of direct open cannulation of the true lumen for rapid access and antegrade perfusion.

Methods: From 4/2006 to 9/2007 13 pts (8 male, mean age 54±12 years) out of 22 with type A AD (12 acute/1 chronic) were operated upon by using this modified approach due to cardiac tamponade in 8 (62%) and/or dissection of the innominate artery with cerebral malperfusion in 6 (46%) pts. After thoracotomy and heparin administration venous cannulation was performed first and blood volume was drainaged by gravity into the ECC reservoir. With the patient in head down position the ascending aorta was cut open at a systolic pressure of less than 30mmHg and a straight cannula inserted into the true lumen by an incision made 2–3cm distally. Under low flow perfusion the aorta was deaired and crossclamped. While cooling the patient the proximal repair was performed first.

Results: The whole manoeuvre took less than 90 seconds and safe arterial access was achieved in all patients. Hospital mortality was 0%. A permanent stroke occurred in 1 (8%) pt with a cerebral malperfusion preoperatively. A transient new neurological deficit was observed in 1 (8%) pt. Thrombembolic events were not detectable.

Conclusion: This novel approach represents a safe and rapid method for arterial access in emergency situations of type A AD providing antegrade perfusion and low risk simultaneously.