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J Thorac Cardiovasc Surg 2006;131:1398-1399
© 2006 The American Association for Thoracic Surgery

Brief Communication

Carotid artery cannulation in acute aortic dissection with malperfusion

Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.

Received for publication January 13, 2006; revisions received January 26, 2006; accepted for publication February 6, 2006.

^_* Address for reprints: Paul Urbanski, MD, PhD, Herz- und Gefaess-Klinik, Salzburger Leite 1, 97616 Bad Neustadt, Germany. (Email: p.urbanski@kardiochirurg.de).

The first 20% of the full text of this article appears below.

Dr Urbanski

Malperfusion has been identified in many series as an independent risk factor for increased perioperative mortality and morbidity in acute aortic dissection. Different approaches for surgical intervention and especially for arterial cannulation are still being discussed to improve surgical outcome in this patient group. ^1–3

We report 2 patients with acute aortic dissection having signs of malperfusion in whom proximal aortic repair with carotid artery cannulation led to excellent surgical outcome.

Clinical Summary

Case 1
A 70-year-old man with a history of hypertension, coronary heart disease, and aortic valve defect experienced sudden thoracic pain 4 years after coronary artery bypass grafting and aortic valve replacement. Shortly after admission to our institution, he was lethargic and not responsive. A computed tomogram (CT)–angiograph of the aorta showed an extended acute aortic dissection involving supra-aortic branches and iliac arteries. The innominate artery and both carotid arteries showed severe compression of the true lumen by the false lumen (Figure 1).

View larger version (37K): [in this window] [in a new window]   Figure 1. Left, Preoperative computed tomogram–angiograph showing aortic dissection involving the aortic arch and supra-aortic vessels with massive compression of the true lumen by the false lumen in . . . [Full Text of this Article]

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