[HSF] Aortic dissection and CPR

[Ani Anyanwu]

Erdinc
 
I would not go as far as saying direct aortic cannulation in type A dissection must be used only in desperate cases. Maybe you should try it one day and you might change your mind. Several surgeons use this approach routinely and I doubt they pray throughout the case. 
 
See for example:
 
Cartier (Montreal) ICTVS 2003 178-180 (they use a guide wire, pressure measurement and echo to ensure placement in true lumen
 
Yamada (Kyoto) ICVTS 2003 175-77 (Also use seldinger with echo guidance used in 12 of 14 patients, they argue it is simpler and quicker and the most certain way to cannulate the true lumen)
 
Jegaden (lyon) JTCVS 2007 134:547-8 (used in 15 of 20 cases)
 
Kron (virginia) JTCVS 2007 133:428-34 (used in 24 cases - lower mortality with central vs peripheral cannulation)
 
Jakob (essen) JTCVS 134 244-5 (8 cases - exanguination, aortic transection and direct cannulation of lumen)
 
Haverich (hannover) JTCVS2003 125:952-3 (14 cases, no attempt to determine true from false lumen).
 
There are several other recent reports of success with this technique since the first case report from the genoa group in 1998 so it appears more and more surgeons are adopting this approach.
 
We should not be too quick to condemn alternative and unconventional techniques without trying them or examining the data; else we may lose potential opportunities to improve on what we do. In fact it is arguable that direct aortic cannulation  - either directly or via the apex, as described by Flege and others - is the only way one can be certain that the true lumen is being perfused. 
 
Ani



> From: enaseri at hotmail.com.tr> To: openheart-l at lists.hsforum.com> Subject: RE: [HSF] Aortic dissection and CPR> Date: Fri, 14 Sep 2007 11:07:42 +0000> > > Direct cannulation of the aorta in dissection cases can at least theoreticaly lead to malperfusion in those cases without any re-entry tear.It must be used only in desperate cases with no other choice ( andpray throughout the case).> erdinc > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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