CONGRESS ABSTRACT

Background:  Cannulation site selection for the surgical treatment of acute type A aortic dissection remains controversial. Several cannulation sites -from femoral to axillary vessels- have been proposed, but each one is associated to the risk of adverse complications. However, in some cases none of them could be an available option due to the dissection extension. Transapical cannulation is a simple maneuver that could restore antegrade blood flow during cardiopulmonary bypass, but only few series have been described in literature. Our aim is to investigate about the safety and efficacy of this procedure. Methods: Between 2000 and 2024, n=355 patients underwent surgical repair of acute type A dissection at our center. Among them, transapical cannulation was performed in n=10 cases. Transapical cannulation was selected as the initial cannulation site in all patients due to unavailability of other places. The main surgical procedures were ascending aorta replacement with open distal technique (n=7), followed by total- (n=2) and partial-arch replacement (n=1). Two cases required an additional bioprosthetic aortic valve replacement. Hypothermic circulatory arrest with antegrade cerebral perfusion was performed in all cases at a mean temperature of 22.5 ± 2 °C, with additional retrograde perfusion in 6 of them. Median cross-clamp and circulatory arrest times were 68 [44,86] and  42 [28,73] minutes, respectively.  Results: 30-day mortality rate was 40% (n=4) and 2 patients died during follow-up at 4 and 6 years, respectively. Three patients had strokes (30%) and four developed postoperative acute kidney disease. Transapical cannulation was successful in all the subjects. One patient showed leg ischemia requiring femoro-femoral bypass. Nobody developed visceral organ malperfusion. The main dissection tear was found in the ascending aorta, aortic arch and root in n=6, n=3 and n=1 patients, respectively.   Conclusions: Despite high mortality rate, transapical cannulation could be a safe and effective bailout option for the repair of acute type A aortic dissection when none other cannulation site is available. Nevertheless, this cannulation method cannot completely reduce the risk of intraoperative malperfusion, especially when large tears are found in ascending aorta, so careful intraoperative monitoring is required.