Aortic arch cannulation with the guidance of transesophageal echocardiography for Stanford type A aortic dissection

Hao Ma,Chaoyi Qin,Jun Shi,Yingqiang Guo,Lulu Liu,Zhenghua Xiao

doi:10.1186/s13019-018-0779-5

Abstract

BackgroundAortic arch cannulation for an antegrade central perfusion during the surgery for Stanford type A aortic dissection can be performed within median sternotomy. We summarize the safety and convenient profile of the central cannulation strategy using the guidance of transesophageal echocardiography (TEE) in comparison to traditional femoral cannulation strategy.MethodsSixty-two patients with acute Stanford type A aortic dissection underwent aortic arch surgery in our hospital. All the patients were operated by the same surgeon. Cannulation was performed in 33 patients through the aortic arch under the guidance of TEE (Group A) and in 29 patients through the femoral artery (Group F). Under moderate hypothermic circulatory arrest, the brain is continuously perfused in an anterograde manner through the brachiocephalic and left common carotid arteries. Preoperative characeristics and surgical information were collected for each patient. Additionally, 30-day mortality rate and the incidence of the temporary neurological dysfunction were recorded as the outcomes. To compare the categorical variables, we used the chi-squared test. Continuous variables were compared using the t-test.ResultsPreoperative characteristics were almost similar between the two groups. The mean operation time (7.33 ± 1.14 h vs. 8.93 ± 2.59 h, P = 0.002) and the mean cardiopulmonary bypass (CPB) time (260.97 ± 45.14 min vs. 298.28 ± 95.89 min, P = 0.024) were significantly shorter in Group A than those in Group F. The 30-day mortality rates were 9.09 and 27.59% in Groups A and F, respectively (P = 0.057). And the incidences of temporary neurological dysfunction were 39.39 and 65.52% in Group A and F, respectively (P = 0.040).ConclusionsAortic arch cannulation with the guidance of TEE during the aortic arch surgery is a simple, fast, safe, and less invasive technique for establishing cardiopulmonary bypass for Stanford type A aortic dissection.

Highlights

Aortic arch cannulation for an antegrade central perfusion during the surgery for Stanford type A aortic dissection can be performed within median sternotomy
Stanford type A aortic dissection is a devastating event associated with major morbidity and mortality and requires immediate surgical repair
What’s more, if the type A aortic dissection extends beyond the brachiocephalic artery, or if the patient has an incomplete circle of Willis, the surgeons would choose not to cannulate via sites like subclavian artery, innominate artery or axillary artery [4, 8]

Summary

Introduction

Aortic arch cannulation for an antegrade central perfusion during the surgery for Stanford type A aortic dissection can be performed within median sternotomy. What’s more, if the type A aortic dissection extends beyond the brachiocephalic artery, or if the patient has an incomplete circle of Willis, the surgeons would choose not to cannulate via sites like subclavian artery, innominate artery or axillary artery [4, 8]. During the early 20th century, several surgeons tried to combine transesophageal echocardiography (TEE) with arterial cannulation to reduce the risk of cannulating into the false lumen [14, 15]. These techniques have been described in numerous studies and have been widely used. The question on which cannulation site is the optimal site remains controversial

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