Carotid cannulation in acute type A aortic dissection

Objectives: Carotid artery cannulation has been established since 2002 at our clinic as the standard approach for surgery of acute type A aortic dissection. The aim of the study was to evaluate the operative and intermediate results. Methods: Between July 2002 and July 2005 26 consecutive patients (median age 61, range, 32–82 years) were operated on because of acute type A dissection. Seven patients suffered from different symptoms of malperfusion preoperatively, with three cases having signs of cerebral malperfusion. In all patients, the carotid artery was cannulated through a side-graft for arterial return. During circulatory arrest, which extended between 18 and 105 minutes (median 36 minutes), the arterial line was used for unilateral cerebral perfusion in moderate hypothermia (median rectal temperature 27.8°C; range, 24.0–30.0°C). Hemiarch- and arch-repair were performed in 12 and 14 cases, respectively. Results: One patient (3.8%) died during the 30-day-postoperative course from colon ischemia. There were no further complications related to perioperative malperfusion, especially, no focal cerebro-vascular events were noted. During follow-up time of up to 3 years, two patients died from non-cardiac related causes and no neurological, vascular or aortic valve related events were observed. Conclusion: Cannulation of carotid artery offers very fast and simple installation of cardio-pulmonary bypass (CPB) even in very obese patients. It provides sufficient arterial perfusion during CPB and enables unilateral cerebral perfusion in moderate hypothermia during circulatory arrest.