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Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection. Division of Cardiovascular Surgery, Nagasaki Kouseikai Hospital, Nagasaki Japan Etsuro Suenaga , Manabu Sato, Hideyuki Fumoto, Hiromitsu Kawasaki. CVC Nagasaki kouseikai HP. Background.

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Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection

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  1. Impact of Transapical Aortic Cannulation for Acute Type A Aortic Dissection Division of Cardiovascular Surgery, Nagasaki Kouseikai Hospital, Nagasaki Japan Etsuro Suenaga, Manabu Sato, Hideyuki Fumoto, Hiromitsu Kawasaki CVC Nagasaki kouseikai HP

  2. Background The femoral artery has been widely used to obtain arterial access for cardiopulmonary bypass in type A aortic dissection. However, retrograde perfusion from the femoral artery sometimes causes serious complications, including organ malperfusion and embolism. Since October 2004, transapical aortic cannulation technique was introduced in our institute. CVC Nagasaki kouseikai HP

  3. Material and Method January, 2000 ～ November, 2009 56 cases: Acute type A Aortic dissection Age: 72±9 years old Male：Female 20:36 Femoral artery cannulation (FA group), 32 cases Transapical aortic cannulation (TAA group), 24 cases All cases were performed graft replacement of ascending aorta under hypothermic circulatory arrest *Exclusion: arch replacement, root replacement and concomitant procedures CVC Nagasaki kouseikai HP

  4. Transapical aortic cannulation Inflow Cannula CVC Nagasaki kouseikai HP

  5. Intraoperative echocardiography Epiaortic echo TEE Inflow Cannula Ａｓｃ．Ａo ＬＡ ＰＡ Inflow Cannula CVC Nagasaki kouseikai HP

  6. Patients characteristics CVC Nagasaki kouseikai HP

  7. Operative findingｓ　 Intimal tear Hemashield 28mm graft All cases were performed graft replacement of ascending aorta under hypothermic circulatory arrest CVC Nagasaki kouseikai HP

  8. Intraoperative factors CVC Nagasaki kouseikai HP

  9. Postoperative course CVC Nagasaki kouseikai HP

  10. Complications • FA group 1 caseWound infection • TAA group 1 casePseudoaneurysm at cannulation site 　　　　　　→ Size reduction by follow up cardiac echo CVC Nagasaki kouseikai HP

  11. Conclusions • Transapical aortic cannulation is a safe, fast technique to establish cardiopulmonary bypass in a hemodynamically unstable patient with acute type A aortic dissection. • The postoperative morbidity and mortality for the two groups were comparable. • TAA cannulation does not affect postoperative cardiac function and compares favorably with FA cannulation. CVC Nagasaki kouseikai HP

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