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sArterial cannulation to establish cardiopulmonary bypass during surgery for acute aortic dissection

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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.

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References

  1. Inoue Y, Minatoya K, Oda T, Itonaga T, Seike Y, Tanaka H, et al. Surgical outcomes for acute type A aortic dissection with aggressive primary entry resection. Eur J Cardiothorac Surg. 2016;50:567–73.

    PubMed  Google Scholar 

  2. Lillehei CW, Cardozo RH. Use of median sternotomy with femoral artery cannulation in open cardiac surgery. Surg Gynecol Obstet. 1959;108:706–14.

    CAS  PubMed  Google Scholar 

  3. Benedetto U, Raja SG, Amrani M, Pepper JR, Zeinah M, Tonelli E, et al. The impact of arterial cannulation strategy on operative outcomes in aortic surgery: evidence from a comprehensive meta-analysis of comparative studies on 4476 patients. J Thorac Cardiovasc Surg. 2014;148:2936–43.

    PubMed  Google Scholar 

  4. Svensson LG, Blackstone EH, Rajeswaran J, Sabik JF 3rd, Lytle BW, Gonzalez-Stawinski G, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg. 2004;78:1274–84; discussion 1274–84.

  5. Parikh N, Trimarchi S, Gleason TG, Kamman AV, di Eusanio M, Myrmel T, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg. 2017;153:S74–S7979.

    PubMed  Google Scholar 

  6. Peterson MD, Mazine A, El-Hamamsy I, Manlhiot C, Ouzounian M, MacArthur RG, et al. Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2015;150:824–31.

    PubMed  Google Scholar 

  7. Abe T, Usui A. The cannulation strategy in surgery for acute type A dissection. Gen Thorac Cardiovasc Surg. 2017;65:1–9.

    PubMed  Google Scholar 

  8. Rylski B, Urbanski PP, Siepe M, Beyersdorf F, Bachet J, Gleason TG, et al. Operative techniques in patients with type A dissection complicated by cerebral malperfusion. Eur J Cardiothorac Surg. 2014;46:156–66.

    PubMed  Google Scholar 

  9. Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg. 2016;5:275–95.

    PubMed  PubMed Central  Google Scholar 

  10. DeBakey ME, Henly WS, Cooley DA, Crawford ES, Morris GC. Surgical treatment of dissecting aneurysm of the aorta analysis of seventy-two cases. Circulation. 1961;24:290.

    Google Scholar 

  11. Fusco DS, Shaw RK, Tranquilli M, Kopf GS, Elefteriades JA. Femoral cannulation is safe for type A dissection repair. Ann Thorac Surg. 2004;78:1285–9.

    PubMed  Google Scholar 

  12. Thomas CS Jr, Alford WC Jr, Burrus GR, Frist RA, Stoney WS. The effectiveness of surgical treatment of acute aortic dissection. Ann Thorac Surg. 1978;26:42–9.

    PubMed  Google Scholar 

  13. Robicsek F, Guarino RL. Compression of the true lumen by retrograde perfusion during repair of aortic dissection. J Cardiovasc Surg (Torino). 1985;26:36–40.

    CAS  Google Scholar 

  14. Parr GV, Manley NJ, Williams DR, Montesano RM. Obstruction of the true lumen during retrograde perfusion of type I aortic dissections: a simplified solution. Ann Thorac Surg. 1980;30:495–8.

    CAS  PubMed  Google Scholar 

  15. Pappas G, Starzl TE. Retrograde false channel perfusion: a complication of cardiopulmonary bypass during repair of dissecting aneurysms. Ann Thorac Surg. 1970;9:263–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Luciani N, Anselmi A, Glieca F, Lauria G, de Geest R, Possati G. Femoral cannulation with long arterial cannula in aortic dissection. Ann Thorac Surg. 2012;93:e45–e4747.

    PubMed  Google Scholar 

  17. Hou XT, Sun YQ, Zhang HJ, Zheng SH, Liu YY, Wang JG. Femoral artery cannulation in Stanford type A aortic dissection operations. Asian Cardiovasc Thorac Ann. 2006;14:35–7.

    PubMed  Google Scholar 

  18. David TE, Armstrong S, Ivanov J, Barnard S. Surgery for acute type A aortic dissection. Ann Thorac Surg. 1999;67:1999–2001.

    CAS  PubMed  Google Scholar 

  19. Immer FF, Aydin NB, Lütolf M, Krähenbühl ES, Stalder M, Englberger L, et al. Does aortic crossclamping during the cooling phase affect the early clinical outcome of acute type A aortic dissection? J Thorac Cardiovasc Surg. 2008;136:1536–40.

    PubMed  Google Scholar 

  20. Van Arsdell GS, David TE, Butany J. Autopsies in acute type A aortic dissection. Surgical implications. Circulation. 1998;98(19 Suppl):II299–302; discussion II302–4.

  21. Minatoya K, Ogino H, Matsuda H, Sasaki H. Rapid and safe establishment of cardiopulmonary bypass in repair of acute aortic dissection: improved results with double cannulation. Interact Cardiovasc Thorac Surg. 2008;7:951–3.

    PubMed  Google Scholar 

  22. Tsiouris A, Elkinany S, Ziganshin BA, Elefteriades JA. Open Seldinger-guided femoral artery cannulation technique for thoracic aortic surgery. Ann Thorac Surg. 2016;101:2231–5.

    PubMed  Google Scholar 

  23. Sabik JF, Lytle BW, McCarthy PM, Cosgrove DM. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg. 1995;109:885–90; discussion 890–1.

  24. Carino D, Mori M, Pang PYK, Singh M, Elkinany S, Tranquilli M, et al. Direct axillary cannulation with open Seldinger-guided technique: is it safe? Eur J Cardiothorac Surg. 2018;53:1279–81.

    PubMed  Google Scholar 

  25. Pasic M, Schubel J, Bauer M, Yankah C, Kuppe H, Weng YG et al. Cannulation of the right axillary artery for surgery of acute type A aortic dissection. Eur J Cardiothorac Surg. 2003;24:231–35; discussion 235–6.

  26. Whitlark JD, Goldman SM, Sutter FP. Axillary artery cannulation in acute ascending aortic dissections. Ann Thorac Surg. 2000;69:1127–28; discussion 1129.

  27. Rylski B, Czerny M, Beyersdorf F, Kari FA, Siepe M, Adachi H, et al. Is right axillary artery cannulation safe in type A aortic dissection with involvement of the innominate artery? J Thorac Cardiovasc Surg. 2016;152:801–7.

    PubMed  Google Scholar 

  28. Imanaka K, Kawata M, Matsuoka T, Yamabi H. Uncertainty of axillary artery perfusion during surgery for acute aortic dissection. Ann Thorac Surg. 2014;97:1781–2.

    PubMed  Google Scholar 

  29. Imanaka K, Kyo S, Tanabe H, Ohuchi H, Asano H, Yokote Y. Fatal intraoperative dissection of the innominate artery due to perfusion through the right axillary artery. J Thorac Cardiovasc Surg. 2000;120:405–6.

    CAS  PubMed  Google Scholar 

  30. Hedayati N, Sherwood JT, Schomisch SJ, Carino JL, Markowitz AH. Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli. J Thorac Cardiovasc Surg. 2004;128:386–90.

    PubMed  Google Scholar 

  31. Klotz S, Heuermann K, Hanke T, Petersen M, Sievers HH. Outcome with peripheral versus central cannulation in acute type A dissection dagger. Interact CardioVasc Thorac Surg. 2015;20:749–53.

    PubMed  Google Scholar 

  32. Sabashnikov A, Heinen S, Deppe A, Zeriouh M, Weymann A, Slottosch I, et al. Axillar or aortic cannulation for aortic repair in patients with stanford A dissection? Ann Thorac Surg. 2016;102:787–94.

    PubMed  Google Scholar 

  33. Schachner T, Nagiller J, Zimmer A, Laufer G, Bonatti J. Technical problems and complications of axillary artery cannulation. Eur J Cardiothorac Surg. 2005;27:634–7.

    PubMed  Google Scholar 

  34. Battaloglu B, Erdil N, Nisanoglu V. Axillary artery perfusion in acute type A aortic dissection repair. J Card Surg. 2008;23:693–6.

    PubMed  Google Scholar 

  35. Watanabe K, Fukuda I, Osaka M, Imazuru T. Axillary artery and transapical aortic cannulation as an alternative to femoral artery cannulation. Eur J Cardiothorac Surg. 2003;23:842–3.

    PubMed  Google Scholar 

  36. Baek WK, Kim YS, Lee M, Yoon YH, Kim JT, Lim HK. Axillary artery cannulation in acute aortic dissection: a word of caution. Ann Thorac Surg. 2016;101:1573–4.

    PubMed  Google Scholar 

  37. Neri E, Massetti M, Capannini G, Carone E, Tucci E, Diciolla F, et al. Axillary artery cannulation in type a aortic dissection operations. J Thorac Cardiovasc Surg. 1999;118:324–9.

    CAS  PubMed  Google Scholar 

  38. Kano M, Chikugo F, Shimahara Y, Urata M, Hayamizu T. Left axillary artery perfusion in surgery of type A aortic dissection. Ann Thorac Cardiovasc Surg. 2008;14:22–4.

    PubMed  Google Scholar 

  39. Taşdemir O, Saritaş A, Küçüker S, Ozatik MA, Sener E. Aortic arch repair with right brachial artery perfusion. Ann Thorac Surg. 2002;73:1837–42.

    PubMed  Google Scholar 

  40. Numata S, Ogino H, Sasaki H, Hanafusa Y, Hirata M, Ando M, et al. Total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion. Eur J Cardiothorac Surg. 2003;23:771–5; discussion 775.

  41. Ogino H, Sasaki H, Minatoya K, Matsuda H, Tanaka H, Watanuki H, et al. Evolving arch surgery using integrated antegrade selective cerebral perfusion: impact of axillary artery perfusion. J Thorac Cardiovasc Surg. 2008;136:641–8; discussion 948–9.

  42. Lijoi A, Scarano F, Dottori V, Parodi E, Casali G, Bartolozzi F. Stanford type A aortic dissection. A new surgical approach. Tex Heart Inst J. 1998;25:65–7.

  43. Minatoya K, Karck M, Szpakowski E, Harringer W, Haverich A. Ascending aortic cannulation for Stanford type A acute aortic dissection: another option. J Thorac Cardiovasc Surg. 2003;125:952–3.

    PubMed  Google Scholar 

  44. Frederick JR, Yang E, Trubelja A, Desai ND, Szeto WY, Pochettino A, et al. Ascending aortic cannulation in acute type a dissection repair. Ann Thorac Surg. 2013;95:1808–11.

    PubMed  Google Scholar 

  45. Inoue Y, Ueda T, Taguchi S, Kashima I, Koizumi K, Takahashi R, et al. Ascending aorta cannulation in acute type A aortic dissection. Eur J Cardiothorac Surg. 2007;31:976–9; discussion 979–81.

  46. Reece TB, Tribble CG, Smith RL, Singh RR, Stiles BM, Peeler BB, et al. Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg. 2007;133:428–34.

    PubMed  Google Scholar 

  47. Brinster DR, Parrish DW, Meyers KS, Reddy P, Kasirajan V. Central aortic cannulation for Stanford type A aortic dissection with the use of three-dimensional and two-dimensional transesophageal echocardiography. J Card Surg. 2014;29:729–32.

    PubMed  Google Scholar 

  48. Suzuki T, Asai T, Matsubayashi K, Kambara A, Kinoshita T, Hiramatsu N, et al. Safety and efficacy of central cannulation through ascending aorta for type A aortic dissection. Interact Cardiovasc Thorac Surg. 2010;11:34–7.

    PubMed  Google Scholar 

  49. Osumi M1, Wada H, Morita Y, Shimizu M, Sukehiro Y, Amako M, et al. Safety and efficacy of ascending aorta cannulation during repair of acute type A aortic dissection. Gen Thorac Cardiovasc Surg. 2014;62:296–300.

  50. Göbölös L, Philipp A, Foltan M, Wiebe K. Surgical management for Stanford type A aortic dissection: direct cannulation of real lumen at the level of the Botallo's ligament by Seldinger technique. Interact Cardiovasc Thorac Surg. 2008;7:1107–9.

    PubMed  Google Scholar 

  51. Ma H, Xiao Z, Shi J, Liu L, Qin C, Guo Y. Aortic arch cannulation with the guidance of transesophageal echocardiography for Stanford type A aortic dissection. J Cardiothorac Surg. 2018;13:106.

    PubMed  PubMed Central  Google Scholar 

  52. Taguchi S, Mori A, Suzuki R, Ishida O. Simplicity, skills, and pitfalls of ascending aortic cannulation for type A aortic dissection. J Cardiothorac Surg. 2013;8:161.

    PubMed  PubMed Central  Google Scholar 

  53. Jakob H, Tsagakis K, Szabo A, Wiese I, Thielmann M, Herold U. Rapid and safe direct cannulation of the true lumen of the ascending aorta in acute type A aortic dissection. J Thorac Cardiovasc Surg. 2007;134:244–5.

    PubMed  Google Scholar 

  54. Conzelmann LO, Weigang E, Kreitner KF, Vahl CF. True-lumen collapse of the ascending aorta in acute type A aortic dissection. Eur J Cardiothorac Surg. 2010;37:955.

    PubMed  Google Scholar 

  55. Yamamoto N, Nie M, Hari Y, Tanaka Y, Ohara K, Miyaji K. A selection of cases of direct cannulation in surgery for type A dissection. Asian Cardiovasc Thorac Ann. 2014;22:284–7.

    PubMed  Google Scholar 

  56. Kitamura T, Nie M, Horai T, Miyaji K. Direct True Lumen Cannulation ("Samurai" Cannulation) for Acute Stanford Type A Aortic Dissection. Ann Thorac Surg. 2017;104:e459–e461461.

    PubMed  Google Scholar 

  57. Kanamori T, Ichihara T, Sakaguchi H, Inoue T. A safe and rapid direct true lumen cannulation for acute type A aortic dissection. Gen Thorac Cardiovasc Surg. 2013;61:336–9.

    PubMed  Google Scholar 

  58. Trinkle JK, Bryant LR. Mechanical support of the circulation: a new approach. Arch Surg. 1970;101:740–3.

    CAS  PubMed  Google Scholar 

  59. Zwart HH, Kralios A, Kwan-Gett CS, Backman DK, Foote JL, Andrade JD, et al. First clinical application of transarterial closed-chest left ventricular (TaCLV) bypass. Trans Am Soc Artif Intern Organs. 1970;16:386–91.

    CAS  PubMed  Google Scholar 

  60. Mansfield PB. Transventricular aortic cannulation for cardiopulmonary bypass in newborn infants. J Pediatr Surg. 1972;7:398–403.

    CAS  PubMed  Google Scholar 

  61. Tanaka T, Kawamura T, Ohara K, Matsumoto M, Maeda H, Hiratsuka H. Transapical aortic perfusion with a double-barreled cannula. Ann Thorac Surg. 1978;25:209–14.

    CAS  PubMed  Google Scholar 

  62. Yamamoto S, Hosoda Y, Yamasaki M, Ishikawa N, Fuchimoto K, Fukuda T. Transapical aortic cannulation for acute aortic dissection to prevent malperfusion and cerebral complications. Tex Heart Inst J. 2001;28:42–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Flege JB Jr, Aberg T. Transventricular aortic cannulation for repair of aortic dissection. Ann Thorac Surg. 2001;72:955–6.

    PubMed  Google Scholar 

  64. Velissaris TJ, Tang AT, Ohri SK. Transventricular cannulation of the aorta: a useful technique in acute aortic dissection. Perfusion. 2001;16:155–7.

    CAS  PubMed  Google Scholar 

  65. Fukuda I, Aikawa S, Imazuru T, Osaka M. Transapical aortic cannulation for acute aortic dissection with diffuse atherosclerosis. J Thorac Cardiovasc Surg. 2002;123:369–70.

    PubMed  Google Scholar 

  66. Sosnowski AW, Jutley RS, Masala N, Alexiou C, Swanevelder J. How I do it: transapical cannulation for acute type-A aortic dissection. J Cardiothorac Surg. 2008;29(3):4.

    Google Scholar 

  67. Wada S, Yamamoto S, Honda J, Hiramoto A, Wada H, Hosoda Y. Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations. J Thorac Cardiovasc Surg. 2006;132:369–72.

    PubMed  Google Scholar 

  68. Suenaga E, Sato M, Fumoto H, Kawasaki H, Koga S. Impact of transapical aortic cannulation for acute type A aortic dissection. Ann Thorac Cardiovasc Surg. 2015;21:382–7.

    PubMed  PubMed Central  Google Scholar 

  69. Djukanovic BP, Micovic S, Peric MS, Milojevic PS, Cirkovic MV, Boricic M, et al. The role of transapical cannulation in the operative management of acute aortic dissection. Perfusion. 2015;30:332–6.

    CAS  PubMed  Google Scholar 

  70. Terasaki T, Takano T, Fujii T, Seto T, Wada Y, Ohtsu Y, et al. Early and midterm results of transapical and right axillary artery cannulation for acute aortic dissection. J Cardiothorac Surg. 2015;10:2.

    PubMed  PubMed Central  Google Scholar 

  71. Matsushita A, Manabe S, Tabata M, Fukui T, Shimokawa T, Takanashi S. Efficacy and pitfalls of transapical cannulation for the repair of acute type A aortic dissection. Ann Thorac Surg. 2012;93:1905–9.

    PubMed  Google Scholar 

  72. Di Eusanio M, Quarti A, Pierri MD, Di Eusanio G. Cannulation of the brachiocephalic trunk during surgery of the thoracic aorta: a simplified technique for antegrade cerebral perfusion. Eur J Cardiothorac Surg. 2004;26:831–3.

    PubMed  Google Scholar 

  73. Di Eusanio M, Ciano M, Labriola G, Lionetti G, Di Eusanio G. Cannulation of the innominate artery during surgery of the thoracic aorta: our experience in 55 patients. Eur J Cardiothorac Surg. 2007;32:270–3.

    PubMed  Google Scholar 

  74. Chiu KM, Li SJ, Lin TY, Chan CY, Chu SH. Innominate artery cannulation for aortic surgery. Asian Cardiovasc Thorac Ann. 2007;15:348–50.

    PubMed  Google Scholar 

  75. Augoustides JG, Harris H, Pochettino A. Direct innominate artery cannulation in acute type a dissection and severe thoracic aortic atheroma. J Cardiothorac Vasc Anesth. 2007;2:727–9.

    Google Scholar 

  76. Kaul P. How I do it–sole innominate cannulation for acute type A aortic dissection. J Cardiothorac Surg. 2012;7:125.

    PubMed  PubMed Central  Google Scholar 

  77. Kaul P. Spontaneous retrograde dissection of ascending aorta from descending thoracic aorta–a case review. Perfusion. 2011;26:215–22.

    PubMed  Google Scholar 

  78. Preventza O, Bakaeen FG, Stephens EH, Trocciola SM, de la Cruz KI. Coselli JS Innominate artery cannulation: an alternative to femoral or axillary cannulation for arterial inflow in proximal aortic surgery. J Thorac Cardiovasc Surg. 2013;145:S191–S196196.

    PubMed  Google Scholar 

  79. Rouchdy A, Abdelrahaman A. Cannulation of innominate artery as an alternative to axillary artery in repair for type A aortic dissection. Journal of the Egyptian Society of Cardio-Thoracic Surgery. 2018;26:83–8.

    Google Scholar 

  80. Urbanski PP. Carotid artery cannulation in acute aortic dissection with malperfusion. J Thorac Cardiovasc Surg. 2006;13:1398–9.

  81. Urbanski PP. Carotid artery cannulation in aortic surgery. Multimed Man Cardiothorac Surg. 2015; doi: 10.1093/mmcts/mmv026

  82. Urbanski PP, Lenos A, Lindemann Y, Weigang E, Zacher M, Diegeler A. Carotid artery cannulation in aortic surgery. J Thorac Cardiovasc Surg. 2006;132:1398–403.

    PubMed  Google Scholar 

  83. Urbanski PP, Irimie V, Wagner M. Cannulation and perfusion strategy in acute aortic dissection involving both common carotid arteries. Interact Cardiovasc Thorac Surg. 2015;21:557–9.

    PubMed  Google Scholar 

  84. Talwar A, Wiadji E, Mathur MN. Experience with the axillary artery as an arterial cannulation site in patients with acute type A aortic dissection. Heart Lung Circ.s. 2018. https://doi.org/10.1016/j.hlc.2018.03.019(Epub ahead of print).

    Article  Google Scholar 

  85. Orihashi K, Sueda T, Okada K, Imai K. Detection and monitoring of complications associated with femoral or axillary arterial cannulation for surgical repair of aortic dissection. J Cardiothorac Vasc Anesth. 2006;20:20–5.

    PubMed  Google Scholar 

  86. Rosinski BF, Idrees JJ, Roselli EE, Germano E, Pasadyn SR, Lowry AM, et al. Cannulation strategies in acute type A dissection repair: A systematic axillary artery approach. J Thorac Cardiovasc Surg. 2018 doi: 10.1016/j.jtcvs.2018.11.137. [Epub ahead of print].

  87. Khaladj N, Shrestha M, Peterss S, Strueber M, Karck M, Pichlmaier M, et al. Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience. Eur J Cardiothorac Surg. 2008;34:792–6; disussion 796.

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Correspondence to Kenji Minatoya.

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Ohno, N., Minatoya, K. sArterial cannulation to establish cardiopulmonary bypass during surgery for acute aortic dissection. Surg Today 50, 1353–1359 (2020). https://doi.org/10.1007/s00595-019-01921-7

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