Acute Dissection of the Ascending Aorta

Acute dissection of the ascending aorta is a lethal disease that requires prompt diagnosis and surgical intervention. It is the most common and disastrous event to affect the aorta. However, in a study, researchers have reported that ideal femoral artery cannulation remains a safe and reliable option for aortic dissection repair. The research has been published in the Journal of Thoracic Disease in the February 2021 issue.

Over the last two decades, there was a shift towards alternative access sites for arterial cannulation for the repair of type A aortic dissections. Initially, the axillary artery became the primary alternative cannulation site. However, the optimal cannulation site for the repair of type A aortic dissection remains controversial. The concern for Malperfusion syndrome has initiated a national trend away from femoral cannulation to the axillary artery and direct ascending aortic cannulation. Dr. Anthony Lemaire and his team conducted a study to report a single-centre experience with femoral artery cannulation for the repair of a type A dissection.

It was a retrospective study on 52 patients who underwent surgical repair for a type A dissection between January 2012 and June 2019 at a single institution. Among 52 patients analyzed, 35 (67.3%) underwent femoral artery, 11 (21.2%) direct ascending aortic, and 6 (11%) axillary artery cannulation for arterial access. The researchers used deep hypothermic circulatory arrest in all patients, and reported the rates of postoperative mortality and complication.

Key Findings of the Study

• Upon analysis, the researchers observed that the rate of mortality and bleeding for all the patients undergoing repair of the type A dissection repairs were 27% (14/52) and 19% (10/52).
• In all patients with femoral arterial cannulation, cardiopulmonary bypass was established. The researchers observed no complications, specifically relating to the three cannulation approaches.
• They found that the bleeding rate for patients with femoral cannulation (13%) was higher compared with the rate for the other cannulation approaches (6%). However, they noted that neither of the bleeding was related to the cannulation site.
• They also noted that none of the mortalities identified were directly attributable to the cannulation approach in each case.

The authors concluded, "Despite the recent shift away from femoral cannulation, the results of the study show that femoral artery cannulation is safe and produces excellent results for establishing cardiopulmonary bypass. The concerns for malperfusion syndrome related to femoral cannulation were not seen."

For further information: https://jtd.amegroups.com/article/view/48528/html