Sosnowski Andrzej W, Jutley Rajwinder S, Masala Nicola, Alexiou Christos, Swanevelder Justiaan
Department of Cardiac Surgery, Glenfield Hospital, Leicester, UK.
J Cardiothorac Surg. 2008 Jan 29;3:4. doi: 10.1186/1749-8090-3-4.
Aortic dissection is the most frequently diagnosed lethal disease of the aorta. Half of all patients with acute type-A aortic dissection die within 48 hours of presentation. There is still debate as to the optimal site of arterial cannulation for establishing cardiopulmonary bypass in patients with type-A aortic dissection. Femoral artery cannulation with retrograde perfusion is the most common method but because of the risk of malperfusion of vital organs and atheroembolism related to it different sites such as the axillary artery, the innominate artery and the aortic arch are used. Cannulation of these sites is not without risks of atheroembolism, neurovascular complications and can be time consuming. Another yet to be popularised option is the transapical aortic cannulation (TAC) described in this article. TAC consists of the insertion of the arterial cannula through the apex of the left ventricle and the aortic valve to lie in the sinus of Valsalva. Trans-oesophageal guidance is necessary to ensure correct placement of the cannula. TAC is an excellent method of establishing cardiopulmonary bypass as it is quick, provides a more physiological method of delivering antegrade arterial flow and is the only method to assure perfusion of the true lumen.
主动脉夹层是最常被诊断出的致命性主动脉疾病。所有急性A型主动脉夹层患者中有一半在就诊后48小时内死亡。对于A型主动脉夹层患者建立体外循环时动脉插管的最佳部位仍存在争议。股动脉插管逆行灌注是最常用的方法，但由于存在重要器官灌注不良及与之相关的动脉粥样硬化栓塞风险，人们开始使用不同部位，如腋动脉、无名动脉和主动脉弓。这些部位的插管并非没有动脉粥样硬化栓塞、神经血管并发症的风险，而且可能耗时较长。本文所述的经心尖主动脉插管（TAC）是另一种尚未普及的选择。TAC包括将动脉插管经左心室心尖和主动脉瓣插入至主动脉窦内。需要经食管引导以确保插管正确放置。TAC是建立体外循环的一种极佳方法，因为它操作迅速，提供了一种更符合生理的顺行动脉血流输送方式，并且是确保真腔灌注的唯一方法。
