AW: [HSF] Aortic dissection and CPR

[Ani Anyanwu]

I have used it only once in my last case - it was not planned but was forced on us by perfusion problems as we could not perfuse true lumen through both the axillary and femoral routes so I cannulated the dissection as last resort.
 
I have seen Haverich's videos and was amazed at the simplicity of his technique; also reading the literature, particularly Kron's paper which surprisingly showed superior results with aortic compared to peripheral cannulation, it is a technique I will employ electively in future. Dissection is however rare in my practice at this time but if and when I get such cases I will certainly be looking to cannulate the aorta if case looks suitable.
 
I must say this is a fairly new approach and goes against conventional teaching so it is not surprising that most surgeons will find the suggestion of direct cannulation unpalatable.
 
Ani



> From: battr at medizin.uni-leipzig.de> To: OpenHeart-L at lists.hsforum.com> Subject: AW: [HSF] Aortic dissection and CPR> Date: Sat, 15 Sep 2007 15:18:37 +0200> CC: > > Ani,> thanks for your bibliography.> And now tell me in how many cases of Type A have you cannulated the aorta,> and your neurological results.> Roberto> > -----Ursprüngliche Nachricht-----> Von: openheart-l-bounces at lists.hsforum.com> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Ani Anyanwu> Gesendet: Freitag, 14. September 2007 17:13> An: openheart-l at lists.hsforum.com> Betreff: RE: [HSF] Aortic dissection and CPR> > 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>> -----------------------------------------> _________________________________________________________________> Celeb spotting – Play CelebMashup and win cool prizes> https://www.celebmashup.com_______________________________________________> 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> -----------------------------------------> > _______________________________________________> 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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