Ann Thorac Surg 2006;81:2340-2341
© 2006 The Society of Thoracic Surgeons
Correspondence
Reply
Yoshimasa Moizumi, MD
Division of Cardiovascular Surgery, Sendai City Medical Center, 5-22-1 Turugaya Miyaginoku Sendai, Miyagiken, 9830824 Japan
(Email: moiuzmi{at}openhp.or.jp).
To the Editor:
We appreciate the comments of Dr Dhareshwar and colleagues [1] regarding our recent article. Our study was designed to identify preoperative and intraoperative predictors of hospital death for acute type A dissection, and the results indicate that the application of axillary artery cannulation was essential for success even if double or single axillary artery cannulation was used [2].
A recent report by Fusco and colleagues [3] showed that cannulation-site related malperfusion rarely occurs; the incidence is 2.5%. However, Estrera and colleagues [4] report that femoral artery cannulation-related cerebral malperfusion was identified in 11% of patients (3 of 28) by means of Power M-mode transcranial Doppler ultrasonography monitoring. The exact incidence of femoral artery, cannulation-related organ malperfusion has not yet been conclusively determined, but the use of more sensitive measures may increase the rate of detection to more than 10%.
Risk of fatal damage to the aortic root and coronary arteries due to retrograde perfusion should also be considered. Expansion of the false lumen arising from retrograde perfusion impairs visceral and cerebral branches sequentially and ultimately compromises coronary arteries. Use of axillary artery cannulation may decrease the incidence of a fatal pump failure.
Many surgeons still prefer femoral artery cannulation for repair of acute type A dissection because of their preconception that axillary artery cannulation is more elaborate and time consuming. However, theoretically, axillary artery cannulation is better than femoral artery cannulation. If preconceptions are laid aside, greater success will be achieved for operations for acute type A dissection [5]. Undoubtedly, the next step is to obtain evidence of the benefits of using the axillary artery versus the femoral artery in a large number of comparable patients.
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References
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- Dhareshwar J, Estrera AL, Achouh P, Porat EE, Safi HJ. Cannulation strategy for acute type A aortic dissection Ann Thorac Surg 2006;81:2340.[Free Full Text]
- Moizumi Y, Motoyoshi N, Sakuma K, et al. Axillary artery cannulation improves operative results for acute type A aortic dissection Ann Thorac Surg 2005;80:77-83.[Abstract/Free Full Text]
- 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]
- 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;129:277-285.[Abstract/Free Full Text]
- Strauch JT, Spielvogel D, Lauten A, et al. Axillary artery cannulationroutine use in ascending aorta and aortic arch replacement. Ann Thorac Surg 2004;78:103-108.[Abstract/Free Full Text]
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