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Ann Thorac Surg 2006;81:2340
© 2006 The Society of Thoracic Surgeons

Correspondence

Cannulation Strategy for Acute Type A Aortic Dissection

Jayesh Dhareshwar, MD, Anthony L. Estrera, MD, Paul Achouh, MD, Eyal E. Porat, MD, Hazim J. Safi, MD

Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Hospital, Houston, TX 77030

(Email: anthony.l.estrera{at}uth.tmc.edu).

To the Editor:

We read with great interest the article by Moizumi and colleagues [1]. We congratulate the authors on their excellent operative results with acute type A aortic dissection.

However, the conclusion of the article that axillary artery cannulation improves operative mortality is misleading. In their group of patients with axillary artery cannulation (n = 69), 57 patients had double arterial cannulation and only 12 had sole axillary arterial cannulation. It would be interesting to see if the results are similar when we compare only axillary artery cases with the femoral group. In addition to hospital mortality, an important endpoint in these cases is the risk of stroke and neurologic outcome, which this article does not address.

Recently, use of the axillary artery for arterial cannulation has become quite popular and almost fashionable. However the benefits of using the axillary artery as opposed to the femoral artery for cannulation have yet to be proven conclusively. In fact a recent article showed that femoral arterial cannulation is perfectly safe for acute type A dissection [2].

In our experience, femoral arterial cannulation is safe for acute type A dissection and can be expeditiously performed in emergency cases. We believe that the use (or lack thereof) of cerebral monitoring to identify malperfusion is more important than the mode of arterial cannulation. We currently use power M-mode transcranial Doppler monitoring, near-infrared spectroscopy, and electroencephalography for cerebral monitoring. We have recently shown the utility of power M-mode transcranial Doppler ultrasonography during the repair of acute type A aortic dissection [3]. It is the use of these aids in the operating room that allow for modification of cannulation at any time during the course of extracorporeal circulation if cerebral malperfusion is detected.


   References
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 References
 

  1. Moizumi Y, Motoyoshi N, Sakuma K, Yoshida S. Axillary artery cannulation improves operative results for acute type A aortic dissection Ann Thorac Surg 2005;80:77-83.[Abstract/Free Full Text]
  2. Fusco DS, Shaw RK, Tranquilli M, et al. Femoral cannulation is safe for type A dissection repair Ann Thorac Surg 2004;78:1285-1289.[Abstract/Free Full Text]
  3. Estrera AL, Garami Z, Miller 3rd CC, et al. Cerebral monitoring with transcranial Doppler ultrasonography improves neurologic outcome during repairs of acute type A aortic dissection J Thorac Cardiovasc Surg 2005;129(2):277-285.[Abstract/Free Full Text]



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Ann. Thorac. Surg., June 1, 2006; 81(6): 2340 - 2341.
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Eyal E. Porat
Hazim J. Safi
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