Objective

Ascending aortic cannulation under ultrasound guidance has been recommended as the technique of choice in acute type A aortic dissection. We performed our first ascending aortic cannulation under ultrasound guidance in November 2013. We describe our experience and how the technique has been taken up in our institution.

Methods

A Teflon buttressed purse string is placed in the ascending aorta. Through this a needle is inserted to a depth, as measured from the pre-operative CT scan, whereby its tip lies in the true lumen. A guidewire is threaded through, and under TOE guidance is advanced into the true lumen of the proximal descending aorta. A Medtronic EOPA cannula (22-20 Fr) is then introduced over this. We retrospectively reviewed cannulation route in all cases of acute dissection from 14/11/13 to 31/10/15.

Results

We operated on 17 acute type A dissections in the study period. Cannulation route utilised is shown in the table. In all cases where it was used, the arterial cannula was placed successfully in the ascending aorta, with no instances of malperfusion as evidenced by equal radial and femoral arterial pressures and satisfactory INVOS readings.

Conclusion

Ascending aortic cannulation under ultrasound guidance is a straightforward and reliable technique that can be easily adopted by other surgeons in acute type A dissection.