Aortic Dissection Flashcards
What is the most common location of tear in TAAD?
Above the commissures between the NCC and LCC
How is valve resuspension done in TAAD?
Transmural pledgeted full thickness sutures at the top of each commissure.
Common mistake is to go too high above the commissure. Must go right at the commissure
Must also obliterate the false lumen at the root. Can use felt or bioglue.
How is AI caused in TAAD?
Caused by flap going into the NCC causing prolapse
Cannulation approach for TAAD Repair
Stable - Innominate not dissected - Sternotomy - Isolate Innominate (graft on before pericardium)
Stable - Innominate dissected - Sternotomy - Go R axillary artery - Central Venous cannulation
Stable - Innominate and axillary dissected - Sternotomy - Go direct aortic cannulation
Stable - All vessels dissected - Axillary dissection and approximate the true and false lumens to perfuse the true lumen with low threshold of alternative strategy like direct aortic cannulation - Make sure you have femoral and radial arterial lines
Unstable (tamponade) - Direct aortic cannulation (seldinger) with TEE guidance (not exam answer)
Unstable (tamponade) if CPR on the table - Femoral arterial cannulation - Femoral venous cannulation - Go on pump - Sternotomy and open
Unstable (tamponade) - Right axillary and femoral venous cannulation
Does pericardial effusion always mean ruptured Aortic dissection?
Often it isn’t, can be a sympathetic response or contained rupture, rarely a frank rupture
