Abstract 754: Ascending Aortic vs. Femoral Cannulation for Acute Aortic Dissection Type A
Objectives: The site of cannulation for repair of ascending aortic dissection remains controversial. Here we present our experience with ascending aortic cannulation for acute aortic dissection type A (AADA).
Methods: From 01/1988 to 09/2007, we operated on 242 patients for AADA. Medical records of 235 patients who received ascending aortic cannulation or femoral cannulation were retrospectively reviewed. Long term follow-up was complete in 97% of patients. Cannulation was accomplished in 82 patients through the ascending aorta and in 153 patients through the femoral artery.
Results: There were no significant differences in preoperative characteristics between groups. Similarly, there were no differences in preoperative patient characteristics and intraoperative parameters including operation time (ascending 357±139 vs. peripheral 342±125 min.; p=0.40), bypass time (ascending 219±105 vs peripheral 206±96 min.; p=0.32), cross-clamp time (ascending 106±43 vs peripheral 106±51 min.; p=0.69), hypothermic circulatory arrest time (ascending 28±19 vs peripheral 27±23 min.; p=0.73), and percentage of total arch replacement (ascending 54.9% vs peripheral 55.7%; p=0.44). Hospital mortality was 12.2% in each group (p=0.98), and incidence of stroke was 4.9% in ascending group and 4.5% in peripheral group (p=0.86). During follow-up (mean 5.5 years), survival at 5 years and 10 years was 65% and 41% in ascending group and 64% and 46% in peripheral group, respectively (p=0.97). No persistent malperfusion by ECC was observed after aortic cannulation.
Conclusions: Direct cannulation of the dissected aorta in patients with AADA was safe with acceptable results in our study cohort. The conventional femoral cannulation had no advantage on the direct cannulation strategy, and the avoidance of additional incision and possible peripheral vascular injury may favor the direct cannulation strategy.