A selection of cases of direct cannulation in surgery for type A dissection

摘要

Background: We use antegrade cannulation, circulatory arrest, and selective antegrade cerebral perfusion in patients with acute aortic dissection. While blood is generally supplied via the ascending aorta, this route can be difficult, depending on the features of dissection and the form of the true lumen. In such cases, we incise the ascending aorta and insert the cannula directly into the true lumen of the ascending aorta to secure the blood supply. Methods: Between April 2005 and April 2012, direct true lumen cannulation of the ascending aorta was performed in 12 patients; 5 had total arch replacement, and 7 had ascending aorta and hemiarch replacement. Results: Total arch replacement involved circulatory arrest for 62.16 min, aortic crossclamping for 174.13 min, cardiopulmonary bypass for 211.11 min, and a minimal rectal temperature of 28.4 C.1.8 C. Ascending aorta and hemiarch replacement involved arrest of the circulation for 40.9 min, aortic crossclamping for 111.29 min, cardiopulmonary bypass for 131.34 min, and a minimal rectal temperature of 27.8 C 0.9 C. One patient died from cerebral infarction during hospitalization. Conclusion: In these cases, direct true lumen cannulation of the ascending aorta was effective.