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Central Cannulation Does Not Increase Adverse Events in Repair Of Acute Ascending Dissection
T. Reece, C. G. Tribble, R. L. Smith, R. Singh, B. M. Stiles, B. B. Peeler, J. A. Kern, I. L. Kron. University of Virginia, Charlottesville, VA,
Background: Site of cannulation for the repair of the dissected aorta remains controversial. It is not clear whether cannulation of the dissected vessel is safe or even preferred. We hypothesized that cannulation of the dissected aorta or peripheral arteries could be done safely with acceptable complication and mortality rates in this high risk population.
Methods: The charts of repairs of acute ascending aortic dissections(n=70) from 1996 to 2004 were reviewed. Cannulation was accomplished in 24 patients via the dissected aorta(Aortic) and 46 patients through cannulation of the femoral or axillary artery(Peripheral). All were converted to sidearm cannulation of the graft for reperfusion. Groups were compared based on comorbidities in addition to mortality, complications, hospital stays and final disposition.
Results: The groups were comparable based on age and preoperative comorbidities. Similarly there were no differences in bypass time, cross clamp time, or hypothermic circulatory arrest time between groups. Postoperative complications, including stroke were similar between groups, but the Peripheral group experienced more cardiac events(Peripheral 15% vs Aortic 0%, p<0.05) and higher mortality compared to Aortic(Peripheral 19.5% vs Aortic 4.2%, p<0.05). The two groups had similar rates of rehabilitation placement. Further separation demonstrated no differences among aortic, axillary and femoral cannulation stroke rates, but that mortality was higher in axillary than aortic cannulation.
Conclusions: Direct cannulation of the dissected aorta was not only safe, but also portended lower mortality and fewer postoperative cardiac events. Cannulation of the dissected aorta does not appear lead to increased adverse events in these high risk patients.
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