sArterial cannulation to establish cardiopulmonary bypass during surgery for acute aortic dissection
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REVIEW ARTICLE
sArterial cannulation to establish cardiopulmonary bypass during surgery for acute aortic dissection Nobuhisa Ohno1 · Kenji Minatoya2 Received: 8 January 2019 / Accepted: 16 October 2019 © Springer Nature Singapore Pte Ltd. 2019
Abstract A cannulation strategy in surgery for Stanford type A acute aortic dissection (AAAD) is integral for patient survival. Femoral cannulation has been the standard option for cannulation; however, there is increasing evidence that retrograde perfusion with femoral cannulation is associated with worse clinical outcomes, and new cannulation sites have been introduced in surgery for AAAD. Although axillary artery cannulation and central cannulation via the ascending aorta have become more popular than femoral access in recent years, adverse events have been reported and shifting cannulation sites during surgery are recommended by some surgeons. Therefore, it is beneficial for surgeons to broaden their knowledge about cannulation technology for AAAD. In this review, we discuss the various methods of cannulation for AAAD. Keywords Acute aortic dissection · Cardiopulmonary bypass · Cannulation · Malperfusion
Introduction Patients with Stanford type A acute aortic dissection (AAAD) present with a variety of symptoms and usually require emergency surgery. In general, entry resection is a basic strategy with graft replacement of the dissected aorta [1]. Cardiopulmonary bypass (CPB) is essential for graft replacement. Since the advent of cardiac surgery, femoral cannulation has been the standard approach for arterial return; however, perfusion from femoral cannulation is retrograde and associated with complications caused by the non-physiological perfusion [2]. Although ascending aortic cannulation has become the standard option for routine cardiac surgery, dissection of the fragile ascending aorta of patients with AAAD is difficult. Therefore, femoral cannulation has become the standard site of cannulation in patients with AAAD. Retrograde perfusion during CPB is non-physiological and believed to involve risks of embolism * Kenji Minatoya [email protected]‑u.ac.jp 1
Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo‑ku, Kyoto 6068507, Japan
2
and multi-organ malperfusion. Several reports suggest that the results of antegrade perfusion in aortic surgery are better [3, 4]. In fact, they indicate a preference of axillary artery cannulation over femoral artery cannulation [5, 6]. However, arteries other than the axillary artery are still cannulated in 25–50% of patients. Thus, the optimal site for arterial cannulation in patients with AAAD remains controversial [79]. In this review, we discuss the strategies used for arterial cannulation in patients with AAAD.
Femoral cannulation Femoral cannulation has long been the standard option for AAAD. In the first large series of surgically treated
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