Angioscopy--a valuable tool in guiding hybrid stent grafting and decision making during type A aortic dissection surgery.

During hypothermic circulatory arrest (HCA), a briefly visible descending aorta is exposed, enabling direct vision to the surgeon. This study evaluated the impact of angioscopy on arch and descending aortic surgery for type A aortic dissection (AD). From December 2007 to March 2009, a flexible bronchovideoscope was used in 21 patients to assure true lumen (TL) positioning of the arterial cannula during open vision aortic cannulation (OVAC; nine of 21 cases) and to inspect the arch and descending aorta for re-entries, guide wire position and target zone for hybrid stent graft (SG) landing (20 of 21 cases). In OVAC, angioscopy secured positioning of the arterial cannula within the TL requiring additional 10-15s of cerebral ischaemia. In 10 of 21 cases, no additional re-entries were found, thus obviating arch replacement in 2 of 21 and stent grafting in 8 of 21. In 11 of 21 cases, SG deployment was guided to the target zone, in three cases incomplete unfolding initiated balloon dilatation. Angioscopy has become an indispensable tool for decision making in AD to apply OVAC, downstream stent grafting and landing zone control with the ability to indicate ballooning at neglectable time requirements during HCA.