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Yadav I, Saifullah H, Mandal AK, I Kh Almadhoun MK, Elsheikh Elabadi HM, Eugene M, Suleman M, Bushra Himedan HO, Fariha F, Ahmed H, Muzammil MA, Varrassi G, Kumar S, Khatri M, Elder M, Mohamad T. Cannulation Strategies in Type A Aortic Dissection: Overlooked Details and Novel Approaches. Cureus 2023; 15:e46821. [PMID: 37954771 PMCID: PMC10636502 DOI: 10.7759/cureus.46821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Aortic dissection type A is a life-threatening condition that frequently necessitates surgical intervention. This review focuses on central aortic cannulation, arch branch vessel (ABV) cannulation, and proximal arch cannulation as key techniques during aortic surgery. It discusses innovative solutions for addressing these challenges. The review synthesizes findings from recent studies and emphasizes the significance of meticulous planning and execution of cannulation in aortic dissection repair. This review aims to contribute to the advancement of surgical practices and the enhancement of patient outcomes in the management of type A aortic dissection (AAD) by addressing these frequently overlooked details.
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Affiliation(s)
- Indresh Yadav
- Internal Medicine, Samar Hospital and Research Center Pvt. Ltd., Janakpur, NPL
- Internal Medicine, Community Based Medical College, Bangladesh, Mymensingh, BGD
| | - Hanya Saifullah
- Medicine and Surgery, CMH Lahore Medical College and the Institute of Dentistry, Lahore, PAK
| | - Arun Kumar Mandal
- Internal Medicine, Manipal College of Medical Sciences/Oda Foundation, Pokhara, NPL
| | | | | | | | | | | | - Fnu Fariha
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Hanzala Ahmed
- Medicine and Surgery, Islamic International Medical College, Riphah International University, Karachi, PAK
| | | | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical University, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Mahir Elder
- Interventional Cardiology, Heart and Vascular Institute, Detroit, USA
| | - Tamam Mohamad
- Cardiovascular, Wayne State University, Detroit, USA
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Deng L, Qin H, Guan Z, Mu Q, Xia Q, Wang M, Huang WH, Gu K. Computational numerical analysis of different cannulation methods during cardiopulmonary bypass of type A aortic dissection model based on computational fluid dynamics. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:667. [PMID: 33987365 PMCID: PMC8106110 DOI: 10.21037/atm-21-605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of the present study was to use a numerical simulation based on computational fluid dynamics (CFD) to analyze the difference of different cannulation methods on hemodynamics characteristic in a type A aortic dissection (TAAD) model. Methods A finite-element analysis based on the CFD model of a TAAD patient was used, and axillary artery cannulation (AAC), innominate artery cannulation (IAC), and femoral artery cannulation (FAC) were analyzed under different situations, including a cardiac output (CO) of 2.5 L/min and cardiopulmonary bypass (CPB) of 2.5 L/min (partial CPB before cross-clamping aorta, defined as condition A), and a CO of 0 L/min and CPB of 5 L/min (aortic cross-clamping phase, defined as condition B). The insertion of an 8-mm cannula into the different models was simulated. Hemodynamic characteristics, including wall shear stress, wall stress, blood flow, and velocity were analyzed. Results In condition A, the total flow of branches of the aortic arch was 2,009.5 mL/min (AAC), 1,855.47 mL/min (IAC), and 1,648.03 mL/min (FAC). All cannulation methods improved left renal blood perfusion. However, in relation to blood flow in the right renal artery, FAC showed the highest blood flow (105 mL/min). The results in condition B were similar to those of condition A. The velocity, shear stress, and stress of entry tear via AAC and IAC decreased in condition B compared with condition A. The velocity, shear stress, stress of tear via AAC was lower than that of IAC. Conclusions Different cannulation modes have an effect on the hemodynamic characteristic of the tear, but this effect is related to different states of CPB. AAC was found to superior to IAC, especially in reducing velocity, stress, and shear stress of site of tear. However, IAC and AAC are more conductive to blood supply than FAC in branch vessels of the aortic arch without being affected by the CPB state.
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Affiliation(s)
- Li Deng
- Affiliated Gaozhou Hospital of Guangdong Medical University, Gaozhou, China.,Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Hao Qin
- Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Zhiyuan Guan
- Peking University Third Hospital, Beijing, China
| | - Qingchun Mu
- Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Qingping Xia
- Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Maosheng Wang
- Clinical Research Center of Digital Medicine and 3D Printing, Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Wen-Hua Huang
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Kaiyun Gu
- National Clinical Research Center for Child Health, The Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
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Xia Q, Cao Y, Xie B, Qiu D, Deng L, Wang M, Han H. Cannulation strategies in type A aortic dissection: a novel insight narrative review. J Thorac Dis 2021; 13:2551-2562. [PMID: 34012600 PMCID: PMC8107572 DOI: 10.21037/jtd-21-411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This review highlights vital details that can be easily overlooked and discuss how to identify and fix failed cannulation from another novel insight. Appropriate arterial cannulation strategy during cardiopulmonary bypass (CPB) in Stanford type A aortic dissection (AAD) is highly necessary to reach satisfactory perfusion effects and appreciable clinical outcomes. Despite several previously published reviews on cannulation strategies in AAD, most focus on the advantages and disadvantages by comparing various cannulation strategies. In fact, most of evidence came from retrospective studies. More importantly, however, some important details and novel approaches maybe overlooked due to variety reasons. These overlooked details also make sense in clinical practice. Papers related to cannulation refer to type AAD were retrieved and analyzed from the PubMed and Medline database. The key words such as “aortic dissection”, “cannula”, “cannulation”, “cannulation strategy”, “cerebral perfusion”, “type I aortic dissection” were conducted and analyzed. In addition, we looked at some new and very significant specific perfusion techniques such as anterograde cerebral perfusion combined with retrograde inferior vena caval perfusion (RIVP) and reperfusion via the right carotid artery before surgery. The arterial cannulation site and strategy should be determined individually. Monitoring measures are very necessary in the whole procedure.
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Affiliation(s)
- Qingping Xia
- Department of Science and Education, The People's Hospital of Gaozhou, Gaozhou, China
| | - Yong Cao
- Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Baodong Xie
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongyun Qiu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Deng
- Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China.,Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Maosheng Wang
- Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, China
| | - Hongguang Han
- Department of Cardiovascular Surgery, The General Hospital of Northern Theater Command, Shenyang, China
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Saw LJ, Lim‐Cooke M, Woodward B, Othman A, Harky A. The surgical management of acute type A aortic dissection: Current options and future trends. J Card Surg 2020; 35:2286-2296. [DOI: 10.1111/jocs.14733] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Li Jing Saw
- School of MedicineUniversity of Liverpool Liverpool UK
| | | | - Beth Woodward
- College of Medical and Dental SciencesUniversity of Birmingham Birmingham UK
| | - Ahmed Othman
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest Hospital Liverpool UK
| | - Amer Harky
- School of MedicineUniversity of Liverpool Liverpool UK
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest Hospital Liverpool UK
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Wai Sang SL, Beute TJ, Timek T. A simple method to establish antegrade cerebral perfusion during hemiarch reconstruction. JTCVS Tech 2020; 2:10-15. [PMID: 34317734 PMCID: PMC8298922 DOI: 10.1016/j.xjtc.2020.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/09/2020] [Accepted: 03/13/2020] [Indexed: 01/16/2023] Open
Abstract
Objective We describe a novel and safe technique using a 12F-14F pediatric arterial cannula to establish unilateral, selective, antegrade cerebral perfusion (ACP) during open hemiarch reconstruction. Methods Between January 2015 and September 2018, 42 patients underwent elective aortic aneurysm repair requiring an open distal anastomosis and at least a hemiarch replacement via hypothermic circulatory arrest by 2 surgeons. All distal reconstructions were performed at moderate hypothermia (22°C-26°C) with direct cannulation of the innominate artery (IA) using a pediatric arterial cannula to allow ACP at 10-15 mL/kg/min. Data were collected by retrospective chart review. Results Thirty-one of the 42 patients (74%) were male. The mean patient age was 65 ± 13 years, and the mean body surface area was 2.1 ± 0.3 m2. Proximal repairs included a modified Bentall with a valve-graft composite (n = 17), valve-sparing root replacement (n = 2), and aortic valve replacement (n = 15). Perioperative mortality was 2% (n = 1), and the incidence of stroke was 0%. The mean lowest core body temperature reached during circulatory arrest was 23.8 ± 2.7°C with a mean ACP time of 21.8 ± 3.6 minutes. The mean aortic cross-clamp and cardiopulmonary bypass times were 160.6 ± 55.5 minutes and 204.7 ± 57.5 minutes, respectively. There were no cases of IA injury. Conclusions Direct IA cannulation with a pediatric arterial cannula is a safe and efficient method to allow ACP in aortic surgery requiring hypothermic circulatory arrest and may circumvent the potential complications of axillary cannulation.
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Affiliation(s)
- Stephane Leung Wai Sang
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich.,Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Tyler J Beute
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Tomasz Timek
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich.,Michigan State University College of Human Medicine, Grand Rapids, Mich
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Harky A, Chan JS, Bithas C, Hof A, Sharif M, Froghi S, Bashir M. Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic Review and Meta-Analysis. Braz J Cardiovasc Surg 2019; 34:213-221. [PMID: 30916132 PMCID: PMC6436790 DOI: 10.21470/1678-9741-2018-0272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. METHODS A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. RESULTS Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. CONCLUSION There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.
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Affiliation(s)
- Amer Harky
- Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom of Great Britain and Northern Ireland
| | - Jeffrey Sk Chan
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Region of the People's Republic of China
| | - Christiana Bithas
- Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom of Great Britain and Northern Ireland
| | - Alexander Hof
- Department of Cardiovascular Surgery, Heinrich-Heine-University, Medical Faculty, Dusseldrof, Germany
| | - Monira Sharif
- School of Medicine, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Saied Froghi
- Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Rd London, United Kingdom of Great Britain and Northern Ireland
| | - Mohamad Bashir
- Manchester Royal Infirmary, United Kingdom of Great Britain and Northern Ireland
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