Assessment of cardiac and pulmonary pressure for transatrial-to-left-ventricular cannulation: implications for surgical safety.

Background: The optimal cannulation strategy in surgery for acute type A aortic dissection (ATAA) remains controversial. A recently introduced transatrial-to-left ventricle (TA-LV) perfusion method allows antegrade perfusion without exposing peripheral vessels. However, concerns regarding the risks of pulmonary oedema and cardiac overdistension during this approach exist. In this study, we aimed to evaluate the hemodynamic safety of this technique and identify perfusion parameters that could mitigate associated risks. Methods: Eighteen patients undergoing emergency surgery for ATAA using TA-LV perfusion were included in this study. A pulmonary artery catheter was placed in each patient to obtain objective hemodynamic measurements. Systemic arterial pressure and pulmonary arterial pressure were monitored throughout the procedure, particularly during the period of ventricular fibrillation (VF). Results: Among 18 cases, 13 patients experienced VF during cooling. During this period, the mean systemic arterial pressure and pulmonary arterial pressure were comparable at approximately 40 mmHg. The median duration of VF was 7 min. No cases developed clinically significant pulmonary oedema or evidence of cardiac overdistension. Conclusions: Maintaining the lowest acceptable perfusion pressure during VF in this perfusion technique may help reduce the risk of cardiac overdistension and pulmonary congestion.