Editorial Commentary
Using apical-aortic cannulation in repair of an acutely dissected aorta is an interesting variation on the conventional femoral cannulation with retrograde perfusion of the acutely dissected aorta. Surgeons are familiar with the complications that may occur after femoral cannulation in the presence of a dissection, which include malperfusion and cerebral embolism.
An acutely dissected aorta can also be repaired by using direct cannulation of the ascending aorta into the dissected aorta. Perfusion, even into the dissected component, usually provides adequate circulation to all regions of the body. After graft replacement of the ascending aorta, perfusion into the fabric graft is completed in a manner similar to that described by Yamamoto and colleagues.
In their technique, the perfusion cannula is removed from the apex of the left ventricle and then inserted into the aortic graft. If the aortic valve is not being replaced, I might instead leave the cannula in the ventricle until cardiac function is restored.
It should be noted that in a few reported cases, apical cannulation of the left ventricle has led to intracavitary thrombosis and embolism. I have recently placed apicoaortic valved grafts in selected patients who had outflow tract obstruction of the left ventricle. 1 None of these patients has developed any ventricular thrombus; however, each patient had been prescribed long-term Coumadin therapy at the time of the implant, because the conduit contained a synthetic valve.