scholarly journals Double arterial cannulation versus right axillary artery cannulation for acute type A aortic dissection: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
He Zhang ◽  
Wei Xie ◽  
Yuzhou Lu ◽  
Tuo Pan ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Lower Incidence ◽  
Axillary Artery ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
Blood Gas ◽  
Type A Aortic Dissection ◽  
Significant Difference

Abstract Background Cannulation strategy in surgery for acute type A aortic dissection (ATAAD) remains controversial. We aimed to retrospectively analyze the safety and efficacy of double arterial cannulation (DAC) compared with right axillary cannulation (RAC) for ATAAD. Methods From January 2016 to December 2018, 431 ATAAD patients were enrolled in the study. Patients were divided into DAC group (n = 341) and RAC group (n = 90). Propensity score matching analysis was performed to compare the early and mid-term outcomes between these two groups. To confirm the organ protection effect by DAC, intraoperative blood gas results and cardiopulmonary bypass parameters were compared between the two groups. Results Demographics and preoperative comorbidities were comparable between two groups, while patients in DAC group were younger than RAC group (51.55 ± 13.21 vs. 56.07 ± 12.16 years, P < 0.001). DAC had a higher incidence of limb malperfusion (18.2% vs. 10.0%, P = 0.063) and lower incidence of coronary malperfusion (5.3% vs. 12.2%, P = 0.019). No significant difference in cardiopulmonary bypass and cross-clamp time was found between the two groups. The in-hospital mortality was 13.5% (58/431), while there was no difference between the two groups (13.5% vs. 13.3%; P = 0.969). Patients who underwent DAC had higher incidence of postoperative stroke (5.9% vs. 0%, P = 0.019) and lower incidence of postoperative acute kidney injury (AKI) (24.7% vs. 40.3%; P = 0.015). During a mean follow-up period of 31.8 (interquartile range, 25–45) months, the overall survival was 81.5% for DAC group and 78.0% for RAC group (P = 0.560). Intraoperative blood gas results and cardiopulmonary bypass parameters showed that DAC group had more intraoperative urine output volume than RAC group (P = 0.05), and the time of cooling (P = 0.04) and rewarming (P = 0.04) were shorter in DAC group. Conclusions DAC will not increase the surgical risks compared to RAC, but could reduce the incidence of postoperative AKI which may be benefit for renal protection.

scholarly journals Double Arterial Cannulation Versus Right Axillary Artery Cannulation for Acute Type A Aortic Dissection: a Retrospective Study

2021 ◽  
Author(s):  
He Zhang ◽  
Wei Xie ◽  
Yuzhou Lu ◽  
Tuo Pan ◽  
Qing Zhou ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Lower Incidence ◽  
Axillary Artery ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
Blood Gas ◽  
Type A Aortic Dissection ◽  
Significant Difference

Abstract Background: Cannulation strategy in surgery for acute type A aortic dissection (ATAAD) remains controversial. We aimed to retrospectively analyze the safety and efficacy of double arterial cannulation (DAC) compared with right axillary cannulation (RAC) for ATAAD.Methods: From January 2016 to December 2018, 431 ATAAD patients were enrolled in the study. Patients were divided into DAC group (n=341) and RAC group (n=90). Propensity score matching analysis was performed to compare the early and mid-term outcomes between these two groups. To confirm the organ protection effect by DAC, intraoperative blood gas results and cardiopulmonary bypass parameters were compared between the two groups.Results: Demographics and preoperative comorbidities were comparable between two groups, while patients in DAC group were younger than RAC group (51.55±13.21 vs. 56.07±12.16 years, P＜0.001 ) . DAC had a higher incidence of limb malperfusion (18.2% vs. 10.0%, P=0.063) and lower incidence of coronary malperfusion (5.3% vs. 12.2%, P=0.019). No significant difference in cardiopulmonary bypass and cross-clamp time was found between the two groups. The in-hospital mortality was 13.5% (58/431), while there was no difference between the two groups (13.5% vs. 13.3%; P=0.969). Patients who underwent DAC had higher incidence of postoperative stroke (5.9% vs. 0%, P=0.019) and lower incidence of postoperative acute kidney injury (AKI) (24.7% vs. 40.3%; P=0.015). During a mean follow-up period of 31.8 (interquartile range, 25-45) months, the overall survival was 81.5% for DAC group and 78.0% for RAC group (P=0.560). Intraoperative blood gas results and cardiopulmonary bypass parameters showed that DAC group had more intraoperative urine output volume than RAC group (P=0.05), and the time of cooling (P=0.04) and rewarming (P=0.04) were shorter in DAC group.Conclusions: DAC will not increase the surgical risks compared to RAC, but could reduce the incidence of postoperative AKI which may be benefit for renal protection.

Direct true lumen cannulation for type A aortic dissection (Samurai technique) in emergency scenarios

2021 ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
False Lumen ◽  
Arterial Occlusion ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
True Lumen ◽  
Type A Aortic Dissection ◽  
Cannulation Site

Choosing the optimal arterial cannulation site in type A aortic dissection may be challenging. Aortic dissection is a dynamic condition that can change at any time. Thus all the alternatives available should be known by surgeons in order to adapt to the possible problems that may arise. In this video tutorial, we present a patient with acute type A aortic dissection who, after cardiopulmonary bypass with axillary arterial cannulation, developed a major complication: intraoperative malperfusion due to pressurization of the false lumen. The patient developed occlusion of the right coronary artery with electrocardiogram changes, inferior akinesia, and ventricular arrhythmias. Cerebral saturation was also significantly decreased. This scenario of acute malperfusion calls for immediate action. We proceeded to switch the cardiopulmonary bypass configuration from axillary to direct true lumen cannulation. This technique, also known as the Samurai technique, is feasible in most cases and advantageous in this emergency situation, allowing prompt reestablishment of adequate perfusion of the true lumen . Some authors even advocate more widespread use of this technique because it may ensure antegrade perfusion while avoiding progression of the dissection flap and reduce the rate of the most common complications of other cannulation sites such as plexus injury during axillary cannulation or cerebral embolization through mobilization of thrombi or calcification from femoral retrograde perfusion. This technique is useful in cases of circumferential dissection and in patients with relative contraindications for peripheral cannulation such as morbid obesity or peripheral arterial occlusion by atherosclerosis or by the dissection itself.

Short- and long-term outcomes of aortic root-sparing repair and replacement in acute type A aortic dissection repair

2021 ◽  
pp. 021849232110150
Author(s):  
Tillana Nirav Tarkas ◽  
Carla Stoicescu ◽  
Wahaj Munir ◽  
Mohamad Bashir ◽  
Benjamin Adams
Keyword(s):  
Decision Making ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Definitive Answer ◽  
Significant Difference ◽  
Current Controversy ◽  
Short And Long Term

Acute type A aortic dissection is a surgical emergency with a high mortality rate if left untreated. Management of the aortic root in this setting constitutes an intricate decision-making framework, further complicated by the emergent nature of the dissection. There exists much controversy regarding pursuit of the aggressive aortic root replacement versus a conservative root-sparing repair, alongside considerations for valve-sparing root replacement. In this review, we critically appraise the current controversy in the literature considering the fate of the aortic root, discussing the aforementioned root interventions for which provides better outcomes for mortality and risk of re-intervention. Literature search was performed using electronic database through PubMed, Google scholar, and Embase focussing on studies reporting outcomes and re-intervention rates for these approaches. Limited by the heterogeneity in surgical strategy, with most studies being single-centred retrospective experiences, further fuel this ongoing debate. The literature reveals rather contrasting results whilst comparing root-sparing repair, versus the extensive root replacement; whilst some studies report no statistically significant difference, others show one superior over the other. There is greater consensus when considering risk of re-operation, with studies showing higher rates of re-operation in root-sparing group compared to replacement; however, many others show no statistically significant difference. In conclusion, the conflicting outcomes reported in the literature, with their inherent limitations, results in the current inability to reach a definitive answer. There remains support in the current literature for both approaches with much of the decision-making being surgeon-bound with many significant influencing factors on a case-by-case basis.

scholarly journals Femoral artery cannulation combined with axillary artery cannulation is safe for Stanford type A aortic dissection

2020 ◽  
Author(s):  
Ling-chen Huang ◽  
Qi-chen Xu ◽  
Dao-zhong Chen ◽  
Xiao-fu Dai ◽  
Liang-wan Chen
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Femoral Artery ◽  
Axillary Artery ◽  
Type A ◽  
Clinical Results ◽  
Type A Aortic Dissection ◽  
Artery Cannulation ◽  
Surgical Data ◽  
Perfusion Time

Abstract Background The optimal cannulation strategy in surgery for Stanford type A aortic dissection is critical to the patients’ survival, but remains controversial. Different cannulation strategies have their own advantages and drawbacks during cardiopulmonary bypass. Our center used femoral and axillary artery cannulation for Stanford type A aortic dissection. The purpose of this study was to review and clarify the clinic outcome of femoral artery cannulation combined with axillary artery cannulation for the treatment of type A aortic dissection. Methods We performed a retrospective study that included 327 patients who were surgically treated for type A aortic dissection in our institution from January 2017 to June 2019.Using femoral and axillary artery cannulation to establish cardiopulmonary bypass in patients with type A aortic dissection. The demographics data and surgical data, clinical results of the patients were calculated. Results Femoral artery combined with axillary artery cannulation was technically successful in 327 patients. The cardiopulmonary bypass time was 141.60 ± 34.89 minutes, and the selective antegrade cerebral perfusion time was 14.94 ± 2.76 minutes. The early mortality was 3.06%. The incidence of permanent neurologic dysfunction was 0.92%. Sixteen patients had post-operative renal insufficiency and five patients with liver failure. Two patients ended up with paraplegia. Conclusion Femoral artery combined with axillary artery cannulation for type A aortic dissection can significantly reduce the occurrence of malperfusion syndrome and nervous system complications, especially for cerebral protection.

scholarly journals Effect of different types of cerebral perfusion for acute type A aortic dissection, unilateral versus bilateral

2020 ◽  
Author(s):  
zhengqin liu ◽  
Chen Wang ◽  
Xiquan Zhang ◽  
Shuming Wu ◽  
changcun fang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Lower Incidence ◽  
Cerebral Perfusion ◽  
Type A ◽  
Neurological Complications ◽  
Neurological Dysfunction ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Neurologic Dysfunction ◽  
Ventilation Time

Abstract Background: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used way for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research was aimed to investigate the clinical effects between u-ACP and b-ACP. Methods: 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP and 197 patients(61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. We also analyzed perioperative variables in order to find the potential associated factors for neurolocial dysfunction (ND). Results: For u-ACP group, 54 patients (43.5%) had postoperative neurological complications including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p=0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p=0.018) and lower incidence of hypoxia (p=0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR=1.20, P= 0.028), CPB duration (OR=3.21, P=0.002 ) and type of cerebral perfusion (OR=1.48, P=0.017) were strongly associated with postoperative ND. Conclusions: In our study, we found that b-ACP procedure had shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia and neurological dysfunction compared to u-ACP. Meanwhile, we discovered the incidence of ND was independently associated with there factors, including preoperative neurological dysfunction, CPB time and type of cerebral perfusion.

scholarly journals Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, unilateral versus bilateral

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhengqin Liu ◽  
Chen Wang ◽  
Xiquan Zhang ◽  
Shuming Wu ◽  
Changcun Fang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Lower Incidence ◽  
Cerebral Perfusion ◽  
Type A ◽  
Neurological Complications ◽  
Neurological Dysfunction ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Neurologic Dysfunction ◽  
Ventilation Time

Abstract Background Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. Methods 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP, and 197 patients (61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. Besides, we also analyzed perioperative variables to find the potential associated factors for neurological dysfunction (ND). Results For u-ACP group, 54 patients (43.5%) had postoperative neurological complications, including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications, including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p = 0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p = 0.018), and lower incidence of hypoxia (p = 0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR = 1.20, p = 0.028), CPB duration (OR = 3.21, p = 0.002), and type of cerebral perfusion (OR = 1.48, p = 0.017) were strongly associated with postoperative ND. Conclusions In our study, it was observed that b-ACP procedure exhibited shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia, and neurological dysfunction compared to u-ACP. Meanwhile, the incidence of ND was independently associated with three factors: preoperative neurological dysfunction, CPB time, and type of cerebral perfusion.

The Rings of Saturn in the Aortic Arch? An Unusual Consequence of Cardiopulmonary Bypass in an Acute Type-A Aortic Dissection

2010 ◽  
Vol 24 (5) ◽  
pp. 887-889
Author(s):  
Haley L.P. Owen ◽  
Jeffrey S. Quintana ◽  
Bryan Matysiak ◽  
Elena J. Holak ◽  
Sandeep Markan ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection
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