Aortic and arch branch vessel cannulation in acute type A aortic dissection repair.
JTCVS Tech
; 12: 1-11, 2022 Apr.
Article
em En
| MEDLINE
| ID: mdl-35403038
ABSTRACT
Objective:
To evaluate central aortic cannulation and arch branch vessel (ABV) cannulation in acute type A aortic dissection repair.Methods:
From 2015 to April 2020, 298 patients underwent open repair of an acute type A aortic dissection. Patients undergoing femoral cannulation for cardiopulmonary bypass (n = 34) were excluded. Patients were then divided based on initial cannulation for cardiopulmonary bypass into central aortic cannulation (n = 72) and ABV cannulation (n = 192) groups. ABV sites included cannulation of the axillary, innominate, right/left common carotid, and intrathoracic right subclavian arteries.Results:
The aortic cannulation group was younger (59 vs 62 years; P = .02), more likely to be men (76% vs 60%; P = .02), and had more peripheral vascular disease (60% vs 37%; P = .0009). ABV dissection was similar between central and ABV cannulation groups (53% vs 60%; P = .51). The aortic cannulation group underwent less aggressive arch replacement, had shorter cardiopulmonary bypass times (200 vs 222 minutes; P = .01), less utilization of antegrade cerebral perfusion (93% vs 98%; P = .04), and received less blood transfusion (0 vs 1 U; P = .001). Postoperative outcomes were similar between aortic and ABV cannulation groups, including stroke (5.6% vs 5.2%; P = 1.0) and operative mortality (4.2% vs 6.3%; P = .77). In addition, postoperative strokes were similar in location (right-brain, left-brain, or bilateral), etiology (embolic vs hemorrhagic), and presence of permanent deficits. Aortic cannulation was not a risk factor for postoperative stroke (odds ratio, 0.94; P = .91) or operative mortality (odds ratio, 0.70; P = .64). Short-term survival was similar between central and ABV cannulation groups.Conclusions:
Both aortic and ABV cannulation were safe and effective cannulation strategies in acute type A aortic dissection repair.
ABV, arch branch vessel; ACP, antegrade cerebral perfusion; ATAAD, acute type A aortic dissection; CPB, cardiopulmonary bypass; HCA, hypothermic circulatory arrest; LCC, left common carotid; RCC, right common carotid; RCP, retrograde cerebral perfusion; RScA, right subclavian artery; TEE, transesophageal echocardiogram; acute type A aortic dissection; aorta; cannulation
Texto completo:
1
Base de dados:
MEDLINE
Tipo de estudo:
Risk_factors_studies
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article