The Transatrial Cannulation Of The Left Ventricle For Acute Type A Aortic Dissection: A 10-year Experience With 235 Patient
Assad Haneya, Mohamed Salem, Julia Zollenkopf, Michael Salib, Veronika Walter, Christine Friedrich, Bernd Panholzer, Thomas Puehler, Georg Lutter, Jan Schoettler, Felix Schoeneich, Jochen Cremer.
University hospital of Kiel, Kiel, Germany.
Objectives. Several arterial cannulation techniques have been proposed to establish cardiopulmonary bypass (CPB) for surgery in patients with acute type A aortic dissection (AAAD). However, the choice of the optimal cannulation strategy remainscontroversial because each one of these has its pros and cons. The aim of the study is to report our 10-year experience with the transatrial cannulation (TAC) of the left ventricle for AAAD surgery. Methods. Since 2010, 235 patients underwent emergency surgery for AAAD using the TAC. In this retrospective analysis, their outcome was compared with that of 185 patients operated on for AAAD using different arterial cannulation techniques between 2004 and 2010 before introduction of the TAC technique. Results. In the TAC group, preoperative cardiac tamponade was present in 21.3% of the patients versus 12.0% in the other group (p=0.013). Otherwise, there were no significant differences with regard to clinical presentations between the two groups concerning important preoperative risk factors. Until 2010, arterial flow was performed with direct cannulation of the distal ascending aorta or the femoral artery. Intraoperatively, operation times [255 min (217;320) vs.295 min (241;356); p<0.001] and blood transfusion [2 units (0;16)vs.4 (0;16); p<0.001] were significantly lower in the TAC group. TAC patients underwent more complex procedures [David operations (8.1% vs. 2.7%; p=0.018) and total arch replacement (17.4% vs. 9.7%; p=0.024)]. Nevertheless, CPB time, cross-clamping times and circulatory arrest times were similar in both groups. Postoperatively, no significant differences were noted between the groups with regard to postoperative complications. Intraoperative mortality (0% vs.2.7%; p = 0.28), 7-day mortality (8.5% vs.14.6%; p = 0.05) and 30-day mortality (15.3% vs.18.9%; p = 0.33) were lower in the group TAC group, but without reaching statistical significance Conclusion. Our experience suggests that TAC proved to be a safe and easy cannulation technique in patients with AAAD. Reduced postoperative the use this cannulation method for this high-risk disease.
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