Central aortic cannulation for Stanford type a aortic dissection with the use of three-dimensional and two-dimensional transesophageal echocardiography.

Background: There is still significant disagreement among surgeons about the best method for arterial cannulation to institute cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection (STAADs). This study aimed to provide support for central aortic cannulation as a viable and preferable option, as it reduces time to institute CPB, operative times, and decreases the complexity of the procedure.

Methods: This study is a retrospective review of 34 patients who underwent STAAD repairs consecutively between October 2006 and January 2014. The sample was analyzed for method of cannulation, CPB time, cross-clamp time, circulatory arrest time, mortality, and complication rate. Statistical analysis was performed to compare a control group of patients who underwent nonaortic cannulation.

Results: The most common method of cannulation was the distal aortic arch, which also produced the lowest relative mortality. The 30-day mortality was found to be 17.6%. Arrhythmia, acute renal injury, and failure to extubate within 48  hours were the most frequent complications, and cerebrovascular accidents occurred in three patients (8.8%). Statistically significant differences in bypass and cardiac arrest times favored aortic cannulation.

Conclusions: This study supports the notion that central aortic cannulation is a viable option for CPB in STAAD repair, but further prospective, randomized trials are necessary for the procedure to replace peripheral cannulation techniques.