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J Thorac Cardiovasc Surg 2007;134:545-547
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

How should I cannulate my next acute aortic dissection?

Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy

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

To the Editor:

We read with interest the article by Reece and associates¹ supporting the feasibility and implying the potential advantage of direct cannulation of the dissected aorta (central cannulation) compared with peripheral cannulation (femoral or axillary) in the management of patients with acute type A aortic dissection. The authors compared retrospectively the results achieved in 24 patients cannulated via the dissected ascending aorta versus 46 cannulated via the femoral artery (n = 31) or the axillary artery (n = 15).

The authors claimed the groups to be comparable on the basis of age and preoperative comorbidities. Similarly, they reported no differences in bypass time, crossclamp time, or hypothermic circulatory arrest time between the two groups. The peripheral group had more cardiac events (peripheral 15% vs central 0%; P < .05) and a higher mortality than the central group (peripheral 19.5% vs central 4.2%; P < .05). The authors conclude that direct cannulation of the dissected aorta is safe and, used with the appropriate indication, might optimize postoperative outcomes in this disease entity.

The complete cardiothoracic surgeon must be adaptable to change and open to new predicaments. It would help, however, if these new thoughts, which often revolutionize much of what has been previously asserted for decades, would result from impeccable studies. Indeed, great methodologic vigilance and lack of bias outline the basic . . . [Full Text of this Article]