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Cardiologia Croatica, Vol. 20 No. 5-6, 2025.

Meeting abstract

https://doi.org/10.15836/ccar2025.168

Central aortic cannulation with transesophageal echocardiography guidance for Stanford type A aortic dissection

Aleksandar Trbović ; Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice, Croatia
Monika Žepić orcid id orcid.org/0009-0007-7975-5199 ; Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice, Croatia
Vedrana Vlahović orcid id orcid.org/0000-0002-8021-4855 ; Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice, Croatia
Krešimir Štambuk orcid id orcid.org/0009-0000-5523-4865 ; Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice, Croatia
Filip Štembal orcid id orcid.org/0000-0003-1688-6152 ; Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice, Croatia

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Abstract

Keywords

central aortic cannulation; Stanford A type aortic dissection; transesophageal echocardiography

Hrčak ID:

330802

URI

https://hrcak.srce.hr/330802

Publication date:

5.5.2025.

Visits: 524 *

Copyright statement: Croatian Cardiac Society

Copyright: 2025, Croatian Cardiac Society

Date received: 16 March 2025

Date: 02 April 2025

Publication date: April 2025

Publication date: April 2025

Volume: 20

Issue: 5-6

Pages: 168-169

Publisher ID: CC 2025 20_5-6_168-9

DOI: 10.15836/ccar2025.168

Article Information (continued)

Categories:

Subject: Extended Abstract

Categories:

Subject: Clinical cases

KEYWORDS: :

KEYWORDS:

Keyword: central aortic cannulation

Keyword: Stanford A type aortic dissection

Keyword: transesophageal echocardiography

Central aortic cannulation with transesophageal echocardiography guidance for Stanford type A aortic dissection

[https://orcid.org/0009-0006-7227-845X] Aleksandar Trbović[*]

[https://orcid.org/0009-0007-7975-5199] Monika Žepić

[https://orcid.org/0000-0002-8021-4855] Vedrana Vlahović

[https://orcid.org/0009-0000-5523-4865] Krešimir Štambuk

[https://orcid.org/0000-0003-1688-6152] Filip Štembal

 

Magdalena Clinic for Cardiovascular Disease, Krapinske Toplice, Croatia

Author notes:

Correspondence to: [*] ADDRESS FOR CORRESPONDENCE: Aleksandar Trbović, Klinika Magdalena, Ulica Ljudevita Gaja 2, HR-49217 Krapinske Toplice, Croatia. / Phone: +385-98-9231-444 / E-mail: trbovicsasa@gmail.com

Acute Stanford type A Aortic dissection is a life-threatening disease in which urgent surgery is primarily life-saving. (1,2) Safe and expeditious initiation of cardiopulmonary bypass (CPB) is important to stabilize the patient’s hemodynamic status and prevent further end-organ damage imposed by the pathophysiologic dissection process. (1) Central aortic cannulation using the Seldinger technique under transesophageal echocardiography (TEE) guidance is a safe cannulation method with the benefit of establishing quick true lumen perfusion and expediting the surgical procedure. (3,4) Both, dynamic and static obstruction of aortic branches are well-described mechanisms of end-organ damage (2), and early pressurization of the true lumen might alleviate those effects. We use TEE-guided ascending aortic central cannulation using the Seldinger technique during surgery in a total number of 3 patients during 2024. All patients were operated by the same surgeon. TEE is used to confirm the position of the guide wire in the true lumen of the descending aorta, and after that needle was taken out, and the cannula was advanced over the guide wire TEE confirmed the accurate positioning of the cannulation into the true lumen (Figures 1-4{ label needed for fig[@id='f2'] }{ label needed for fig[@id='f3'] }{ label needed for fig[@id='f4'] }). It was achieved in all 3 patients. Aortic arch cannulation with the guidance of TEE during the aortic arch surgery is a simple, fast, safe, and less invasive technique for establishing cardiopulmonary bypass for Stanford type A aortic dissection. (4)

FIGURE 1 True lumen identification.
CC202520_5-6_168-9-f1
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FIGURE 2 True lumen cannula.
CC202520_5-6_168-9-f2
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FIGURE 3 True lumen cannula color Doppler flow.
CC202520_5-6_168-9-f3
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FIGURE 4 True lumen flow on cardiopulmonary bypass.
CC202520_5-6_168-9-f4

LITERATURE

1 

Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt TM 3rd, et al. AATS Clinical Practice Standards Committee. Adult Cardiac Surgery. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2021 September;162(3):735–758.e2. https://doi.org/10.1016/j.jtcvs.2021.04.053 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/34112502

2 

Isselbacher EM, Preventza O, Hamilton Black J 3rd, Augoustides JG, Beck AW, Bolen MA, et al. Peer Review Committee Members. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 December 13;146(24):e334–482. https://doi.org/10.1161/CIR.0000000000001106 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/36322642

3 

Ramaprabhu K, Saran N, Dearani J, Lahr B, Schaff H, Greason K, et al. Cannulation strategies for acute type A dissection-role of central cannulation. Eur J Cardiothorac Surg. 2022 August 3;62(3):ezac207. https://doi.org/10.1093/ejcts/ezac207 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/36125069

4 

Ma H, Xiao Z, Shi J, Liu L, Qin C, Guo Y. Aortic arch cannulation with the guidance of transesophageal echocardiography for Stanford type A aortic dissection. J Cardiothorac Surg. 2018 October 11;13(1):106. https://doi.org/10.1186/s13019-018-0779-5 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/30309362

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