The direct aortic cannulation for acute type A aortic dissection.

Abstract

This article describes the surgical techniques demonstrated in our video, “The Direct Aortic Cannulation for Acute type A Aortic Dissection”. Acute type A aortic dissection is a life-threatening condition requiring emergency operation. The choice of arterial cannulation sites to institute cardiopulmonary bypass is still a topic of controversy. Central cannulation directly through the ascending aorta has been reported (1,2). It has a theoretical advantage of not changing the natural antegrade blood flow, and in doing so avoiding intraoperative malperfusion. We believe that accurate positioning of the tip of an arterial cannula is best achieved with epiaortic echo guidance. We use the Seldinger method through the non-dissected part of the aortic wall in most cases, usually via the left side of the ascending aorta. In the current video presentation (Video 1), only the small posterior aspect was not dissected. The case was also complicated by intermittent myocardial ischemia, bicuspid aortic valve and significantly dilated ascending aorta. Video 1 The direct aortic cannulation for acute type A aortic dissection. Here we describe in detail our surgical technique for direct aortic cannulation by the Seldinger method with epiaortic guidance.