PONE-D-20-21577

Direct true lumen cannulation in type A acute aortic dissection

PLOS ONE

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Reviewers' comments:

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Reviewer #2: Yes

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Reviewer #2: Yes

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Reviewer #2: Yes

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Reviewer #2: Yes

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Reviewer #1: 528 patients with Type A aortic Dissection (2006-2017) where a unique Direct True Lumen cannulation technique was employed n 52.4% of their patients with similar outcomes (which are acceptable ~30 day mortality 12%, 8% new neuro deficits) to their conventional peripheral cannulation techniques (same).

Their novel direct technique involves encircling the dissected aorta (dangerous) and a brief normothermic drop in temperature (also dangerous) and dividing the dissected aorta to place the aortic cannula under direct vision (more dangerous) and would be best reserved for experienced surgeons.

At our center and at Penn, direct cannulation is performed using a “Seldinger” wire technique under epi-aortic ultrasound and TEE guidance, which is much safer (in my opinion) with similar outcomes in obtaining true lumen cannulation and avoiding the pitfalls of peripheral cannulation.

For this article to be published, The discussion should include references to the Seldinger technique and specific reasons why the Mainz center group feels their approach is preferred.

Furthermore, if published the manuscript would benefit from figures showing their preferred technique.

Reviewer #2: Thanks for your nice report.

Another article about femoral cannulation that you might cite is Fusco, DS. Ann Thorac Surg. 2004 Oct;78(4):1285-9; discussion 1285-9.

Your paper could be enhanced by a nice accompanying drawing of your cannulation technique.

Although you demonstrated no benefit from this arterial cannulation technique over other methods, the description of your technique is still valuable.

How often did you have troubling bleeding from around the cannula during perfusion?

Did your surrounding aortic tapes ever tear through the fragile aortic layers.

Among the other cannulation options, you mention "left atrial". Please explain.

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Reviewer #1: No

Reviewer #2: Yes: John A. Elefteriades, MD

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Direct true lumen cannulation in type A acute aortic dissection: A review of an 11 years’ experience

PONE-D-20-21577R1

Dear Dr. El Beyrouti,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Prof. Raffaele Serra, M.D., Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

amended manuscript is acceptable

Reviewers' comments: