Reply to the Letter to the Editor – True Lumen Cannulation for the Tool Kit in Type A Aortic Dissection

I appreciate the interest in our article “Use of a Carotid Artery for Arterial Cannulation: Side-Related Differences” [1] very much; however, the aim of our study was not to speculate on the best cannulation site in surgery for acute type A dissection but to demonstrate the general feasibility of carotid artery cannulation for arterial return in aortic arch surgery.

Even if it could be demonstrated that aortic true lumen cannulation of the ascending aorta is a practicable option in selected patients with acute type A aortic dissection, one should bear in mind that this pathology is only a small part (about 10 %) of the entire arch surgery. Because atherosclerotic aneurysm is the most frequent indication for arch surgery and there is well-known evidence that the atherosclerotic aortic wall is the main source of cerebral embolism in cardiac surgery, direct cannulation of the aorta can not be recommended in such cases.

Regarding acute aortic dissection especially, another disadvantage of aortic cannulation should also be considered: the necessity of interrupting cerebral perfusion for distal revision or repair of the arch during circulatory arrest. Moreover, when selective cerebral perfusion is carried out for brain protection, additional cannulation of the dissected and damageable arch arteries with perfusion catheters has to be considered as an increased risk for neurovascular or local vascular complications. Direct cannulation of the aorta may also be insufficient in cases with cerebral malperfusion caused by obliteration of the arch arteries. In such cases, cannulation of the carotid artery distal to the obstruction ensures sufficient cerebral perfusion while the second arterial line provides global perfusion [2].

Prof. Dr. Paul P. Urbanski

References

• 1 Urbanski P P, Lenos A, Lindemann Y, Zacher M, Frank S, Diegeler A. Use of a carotid artery for arterial cannulation: side-related differences.  Thorac Cardiov Surg. 2010;  58 276-279
• 2 Urbanski P P. Carotid artery cannulation in acute aortic dissection with malperfusion.  J Thorac Cardiovasc Surg. 2006;  131 1398-1399