Central cannulation strategy for extent I thoracoabdominal aneurysm repair of chronic type B aortic dissection

Introduction: We evaluated the safety profile of a central cardiopulmonary bypass (CPB) cannulation strategy for repair of extent I thoracoabdominal aortic aneurysms (TAAA) with chronic type B dissection in comparison to traditional peripheral CPB cannulation strategies.

Methods: Patients undergoing extent I TAAA repair for chronic type B dissection from 2002 to 2011 were retrospectively reviewed. Patients were grouped by their CPB cannulation strategy. Patients in Group I underwent central aortic cannulation (n = 28) through a left thoracotomy incision. The true lumen of the descending thoracic aorta was cannulated using an echocardiogram-guided Seldinger wire technique. The right atrium was directly accessed for venous drainage. In Group II (n = 31), arterial and venous cannulation of the femoral vessels was achieved using a left-sided groin incision. All patients underwent deep hypothermic circulatory arrest for proximal aortic reconstruction.

Results: Preoperative aortic dimensions (6.5 ± 0.79 cm in Group I vs 7.0 ± 1.15 cm in Group II p = 0.8) were similar between groups. CPB time (240 ± 37 min in Group I vs 174 ± 68 min in Group II p < 0.01) was significantly higher in the central cannulation group whereas circulatory arrest times (43 ± 5 min Group I vs 37 ± 7 min in Group II p = 0.1) were similar between the two groups. In-hospital 30-day mortality (N = 0, 0% in Group I; N = 2, 6.5% in Group II), stroke (N = 1, 3.5% in Group I; N = 0, 0% in Group II), paraplegia (N = 1, 3.5% in Group I; N = 1, 3.2% in Group II), reoperation for bleeding (N = 1, 3.5% in Group I; N = 1, 3.2% Group II), tracheostomy rate (N = 2, 7% in Group I; N = 3, 9.7% Group II), and mean length of stay (19 days in Group I vs 17 days in Group II) were similar (p > 0.05). Median follow-up was 3.6 ± 2.0 in Group I and 5.6 ± 2.6 years in Group II. Actuarial survival at 5 years was 84.6 % for Group I and 77.6% for Group II (p = 0.52).

Conclusions: Central true lumen cannulation through a left thoracotomy incision for repair of extent I TAAA with chronic type B dissection is an acceptable approach with equivalent early and midterm outcomes compared to more standard femoral cannulation techniques. It may provide a safe alternative cannulation site for patients with diseased femoral vessels.