The cannulation strategy in surgery for acute type A dissection

• Published in: General thoracic and cardiovascular surgery Vol. 65; no. 1; pp. 1 - 9
• Main Authors: Abe, Tomonobu, Usui, Akihiko
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.01.2017; Springer Nature B.V
• Subjects: Acute Disease; Aneurysm, Dissecting - surgery; Aortic Aneurysm - surgery; Aortic dissection; Axillary Artery; Cardiac Catheterization - methods; Cardiac Surgery; Cardiology; Cardiopulmonary Bypass - methods; Cooling; Coronary vessels; Current Topics Review; Current Topics Review Article; Femoral Artery; Humans; Ischemia; Medicine; Medicine & Public Health; Mortality; Patients; Perfusion - methods; Retrospective Studies; Stroke; Surgeons; Surgical Oncology; Surgical techniques; Thoracic Surgery; Treatment Outcome; Veins & arteries; Dissecting aneurysm; Cardiopulmonary bypass; Aorta; Femoral artery; Axillary artery
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-016-0711-7

The rates of mortality and morbidity remain high in surgery for acute type A dissection. There is controversy regarding the best cannulation strategy for achieving good clinical results. Each cannulation technique has different anatomical characteristics and a different flow pattern inside the aorta during cardiopulmonary bypass. Some adverse, clinically important outcomes may be related to events at this time. Femoral artery cannulation, axillary artery cannulation, and central aortic cannulation are the three major cannulation strategies that are adopted in many centers in the world. Accumulating results from comparative studies between right axillary artery cannulation and femoral artery cannulation show that right axillary artery cannulation is associated with better clinical outcomes. However, all of the studies have been retrospective, and few studies have compared the results of other combinations of cannulation strategies. Observational studies using newer monitoring techniques clearly show that no perfusion strategy is perfect or free from complications. In summary, the evidence is insufficient to make a strong recommendation regarding cannulation strategies. Based on the fairly consistent results of retrospective studies, more surgeons are tending to switch from a retrograde perfusion strategy to adopt an antegrade perfusion strategy. Regardless of the routine cannulation strategy that is adopted, careful monitoring and a swift response to adverse events are necessary. The further accumulation of evidence is warranted.