Central aortic cannulation for Stanford type a aortic dissection with the use of three-dimensional and two-dimensional transesophageal echocardiography.

BACKGROUND: There is still significant disagreement among surgeons about the best method for arterial cannulation to institute cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection (STAADs). This study aimed to provide support for central aortic cannulation as a viable and preferable option, as it reduces time to institute CPB, operative times, and decreases the complexity of the procedure. METHODS: This study is a retrospective review of 34 patients who underwent STAAD repairs consecutively between October 2006 and January 2014. The sample was analyzed for method of cannulation, CPB time, cross-clamp time, circulatory arrest time, mortality, and complication rate. Statistical analysis was performed to compare a control group of patients who underwent nonaortic cannulation. RESULTS: The most common method of cannulation was the distal aortic arch, which also produced the lowest relative mortality. The 30-day mortality was found to be 17.6%. Arrhythmia, acute renal injury, and failure to extubate within 48 hours were the most frequent complications, and cerebrovascular accidents occurred in three patients (8.8%). Statistically significant differences in bypass and cardiac arrest times favored aortic cannulation. CONCLUSIONS: This study supports the notion that central aortic cannulation is a viable option for CPB in STAAD repair, but further prospective, randomized trials are necessary for the procedure to replace peripheral cannulation techniques.

Repeat computed tomography for trauma patients undergoing transfer to a Level I trauma center.

Our goal was to determine the characteristics of trauma transfer patients with repeat imaging. A retrospective trauma registry review was performed to evaluate trauma patients who were transferred from referring institutions between January 2005 and December 2009. Patients were divided into those who had a duplicate computed tomography (CT) scan versus those who did not. There were 2678 patients included of whom 559 (21%) had at least one repeat CT scan, whereas 2119 (79%) did not have any repeat CT scans. Those with repeat CT scans were older (42.3 ± 27.3 years vs 37.3 ± 25.6 years), had a higher Injury Severity Score (ISS) (13.7 ± 8.7 vs 11.9 ± 8.8), and more likely to have blunt trauma (odds ratio, 4.7; confidence interval, 2.3 to 9.6) (P for all < 0.0007). Those with CT scans done only at the referring facility were younger, had a lower ISS, and shorter lengths of stay (P for all < 0.0003). ISS and age were independent predictors for repeat CT scans. Transfer patients had imaging repeated one-fifth of the time. The younger, less injured patient went without repeat imaging suggesting that they may have been adequately cared for at the outside institution.