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Correspondence

Direct True Lumen Cannulation in Surgery for Acute Type A Aortic Dissection Is a Valuable but Risky Alternative

Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Route 0528, Galveston, TX 77555-0528

(Email: slick{at}utmb.edu).

To the Editor:

We read with interest Conzelmann and colleagues' [1] recent article. The authors successfully used controlled exsanguination into the cardiopulmonary bypass circuit, and rapid, warm, beating heart open mid-ascending aortic true lumen cannulation, followed by circumferential aortic snaring, initiation of cardiopulmonary bypass, and deep hypothermic circulatory arrest in 29 patients.

In the authors' hands, this technique appears safe, efficient, and effective, but it brings to mind a patient we operated on with an aortic dissection who had a 360° circumferential separation of the true lumen from the false lumen near the sinotubular junction. The true lumen was tethered by dissection extension into the arch vessels, and the entire ascending true lumen was free-floating inside the arch and down the descending aorta, requiring careful identification and teasing backward. Although such an anatomy is rare (most dissections involve > 50% of the circumference, but few involve the entire circumference), it was difficult enough to sort out under deep hypothermic circulatory arrest and peripheral cannulation; we can only imagine it would be much more difficult, if not impossible, to quickly sort out in a warm, beating heart situation, leading to possible false-lumen cannulation or disastrous false-lumen perforation.

The technique they describe sounds like a valuable alternative for the aortic surgeon faced with a peripheral cannulation problem, but it sounds a bit risky to be considered a routine approach for ascending dissections.

	References

Top References

 

1. Conzelmann LO, Kayhan N, Mehlhorn U, Weigang E, Dahm M, Vahl CF. Reevaluation of direct true lumen cannulation in surgery for acute type A aortic dissection Ann Thorac Surg 2009;87:1182-1186.[Abstract/Free Full Text]

This article has been cited by other articles:

				L. O. Conzelmann, N. Kayhan, U. Mehlhorn, E. Weigang, M. Dahm, and C. F. Vahl Reply Ann. Thorac. Surg., November 1, 2009; 88(5): 1727 - 1728. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Scott D. Lick Andras Kollar Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lick, S. D. Articles by Kollar, A. Search for Related Content PubMed PubMed Citation Articles by Lick, S. D. Articles by Kollar, A. Related Collections Great vessels Related Article