Aortic Cannulation

Abstract

There are many potential complications of cardiopulmonary bypass. Perhaps it is most remarkable that bypass is conducted so safely despite the catastrophic potential. In this case, during what should have been a straightforward operation to relieve a muscle bridge, your patient experienced an intraoperative aortic dissection identified by direct inspection and confirmed by transesophageal echo. You wean from bypass and establish perfusion via the femoral artery. Cooling to 18° for circulatory arrest you repair the ascending aorta with resuspension of the aortic valve at the sinotubular junction and perform your distal anastomosis as a hemiarch replacement, recannulating for antegrade flow before reinstituting bypass. The management of intraoperative aortic dissection is reviewed including repair techniques. Intraoperative dissection is uncommon but demands immediate appropriate repair.