Impacts of Direct Ascending Aortic Cannulation using the Seldinger’s technique for Aortic Arch Surgery

Jae hyun Kim, Woo Sung Jang, Jae-Bum Kim

Keimyung University, Dongsan Medical Center, Daegu, Korea (South)

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Purpose: The site of cannulation for aortic arch repair remains controversial. Although axillary artery cannulation gains more popularity over femoral cannulation, it also has drawbacks of long preparation time and risk of malperfusion. We evaluated the safety and effectiveness of direct ascending aortic cannulation using ultrasound-guided Seldinger technique during aortic arch repair.

Methods: Between 2013 and 2017, 65 patients underwent aortic arch repair (54 hemi-arch, 2 partial arch, 9 total arch) for acute type A aortic dissection (n = 45), chronic type A aortic dissection (n = 9), or aortic aneurysm (n = 11). Direct ascending aortic cannulation group (Central, n = 17) was compared with axillary and/or femoral artery cannulation group (Peripheral, n = 48). All data were retrieved from the medical records and retrospectively reviewed.

Results: In terms of mortality and morbidity, there was no difference between the two groups. Aortic rupture or malperfusion related to the direct ascending aorta cannulation was not occurred. CPB establishment after skin incision was faster in central group than peripheral group (39 vs. 55 minutes, p = 0.001). And also, operation time were shorter in central group than peripheral one (279 vs 375 minutes, P < 0.001). There were no difference in ACC, CPB and TCA time between the two groups. Subgroup analysis for acute type A aortic dissection also showed consistent results of faster CPB establishment and shorter operation time.

Conclusion: Direct ascending aortic cannulation was safe and fast compared with peripheral cannulation in aortic arch surgeries. Direct ascending aortic cannulation would be more useful in patients who need rapid establishment of antegrade systemic perfusion in the situations of hemodynamic instability or acute type A aortic dissection.