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

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.

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Combined femoral and axillary perfusion strategy for Stanford type A aortic dissection repair

10.21203/rs.3.rs-55538/v2 ◽

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 ◽

Demographic Data ◽

Type A ◽

Clinical Results ◽

Type A Aortic Dissection ◽

Artery Cannulation ◽

Surgical Data

Abstract Background: The optimal cannulation strategy in surgery for Stanford type A aortic dissection is critical to patient survival but remains controversial. Different cannulation strategies have their own advantages and drawbacks during cardiopulmonary bypass. Our centre used a combined femoral and axillary perfusion strategy for the surgical treatment of type A aortic dissection. The purpose of this study was to review and clarify the clinical outcome of femoral artery cannulation combined with axillary artery cannulation for the treatment of Stanford 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. Femoral and axillary artery cannulation was used to establish cardiopulmonary bypass in patients with type A aortic dissection. The demographic data, surgical data, and 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 rate was 3.06%. The incidence of permanent neurologic dysfunction was 0.92%. Sixteen patients had postoperative renal insufficiency, and five patients had liver failure.Conclusion: Femoral artery combined with axillary artery cannulation for type A aortic dissection can significantly improve the prognosis of patients, especially in terms of cerebral protection, and can reduce the occurrence of adverse malperfusion syndrome and neurological complications.

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Combined femoral and axillary perfusion strategy for Stanford type a aortic dissection repair

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01371-0 ◽

2020 ◽

Vol 15 (1) ◽

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 ◽

Demographic Data ◽

Type A ◽

Clinical Results ◽

Type A Aortic Dissection ◽

Artery Cannulation ◽

Surgical Data

Abstract Background The optimal cannulation strategy in surgery for Stanford type A aortic dissection is critical to patient survival but remains controversial. Different cannulation strategies have their own advantages and drawbacks during cardiopulmonary bypass. Our centre used a combined femoral and axillary perfusion strategy for the surgical treatment of type A aortic dissection. The purpose of this study was to review and clarify the clinical outcome of femoral artery cannulation combined with axillary artery cannulation for the treatment of Stanford 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. Femoral and axillary artery cannulation was used to establish cardiopulmonary bypass in patients with type A aortic dissection. The demographic data, surgical data, and 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 min, and the selective antegrade cerebral perfusion time was 14.94 ± 2.76 min. The early mortality rate was 3.06%. The incidence of permanent neurologic dysfunction was 0.92%. Sixteen patients had postoperative renal insufficiency, and five patients had liver failure. Conclusion Femoral artery combined with axillary artery cannulation for type A aortic dissection can significantly improve the prognosis of patients, especially in terms of cerebral protection, and can reduce the occurrence of adverse malperfusion syndrome and neurological complications.

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Is Axillary Better Than Femoral Artery Cannulation in Repair of Acute Type A Aortic Dissection?

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519836879 ◽

2019 ◽

Vol 14 (2) ◽

pp. 124-133 ◽

Cited By ~ 1

Author(s):

Eilon Ram ◽

Yoav Krupik ◽

Alexander Lipey ◽

Ami Shinfeld ◽

Yael Peled ◽

...

Keyword(s):

Renal Failure ◽

Aortic Dissection ◽

Femoral Artery ◽

Operative Mortality ◽

Axillary Artery ◽

Type A ◽

Acute Type ◽

Complication Rates ◽

Type A Aortic Dissection ◽

Artery Cannulation

Objective We compared early and late outcomes of patients who underwent femoral versus axillary artery cannulation for repair of acute type A aortic dissection. Methods Between 2004 and 2017, we retrospectively evaluated the clinical outcomes of 135 consecutive patients who underwent emergency surgery for acute type A aortic dissection repair. Patients were divided into 2 groups: those who underwent femoral ( n = 84) and those who underwent right axillary ( n = 51) artery cannulation. Mean patient age was 63 ± 13 years and 88 (65%) were male. Results Overall operative mortality was 12.6% (axillary 15.7%, femoral 10.7%; P = 0.564). Patients who underwent axillary compared to femoral artery cannulation had a statistically nonsignificant higher operative mortality rate among both stable and unstable patients (13% vs. 6.5%, P = 0.405 and 40% vs. 22.7%, P = 0.818, respectively). While there was no difference in major complication rates, such as stroke, low cardiac output, and surgical revision for bleeding/tamponade, there was a higher incidence of renal failure that required dialysis in patients who underwent axillary cannulation (12% vs. 1%, P = 0.022). Multivariate analysis demonstrated that predictors for the composite endpoint of operative mortality or severe organ malperfusion, such as renal failure or cerebrovascular accident, were hemodynamic instability on admission (OR 3.87; 95% CI, 1.23 to 12.63; P = 0.021), lower preoperative creatinine clearance (OR 0.94; 95% CI, 0.90 to 0.97; P < 0.001); and the use of axillary artery cannulation (OR 4.1; 95% CI, 1.43 to 12.78; P = 0.011). Among those discharged from hospital, the 3-year survival rate was 91% in the axillary group and 87% in the femoral group ( P = 0.772). Conclusions Based on our experience, emergent surgery for both stable and unstable patients with acute type A aortic dissection demonstrated similar survival rates and significantly less renal impairment when using the femoral cannulation approach.

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Axillary artery cannulation in type a aortic dissection operations

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(99)70223-0 ◽

1999 ◽

Vol 118 (2) ◽

pp. 324-329 ◽

Cited By ~ 101

Author(s):

Eugenio Neri ◽

Massimo Massetti ◽

Gianni Capannini ◽

Enrico Carone ◽

Enrico Tucci ◽

...

Keyword(s):

Aortic Dissection ◽

Axillary Artery ◽

Type A ◽

Type A Aortic Dissection ◽

Artery Cannulation

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An unusual complication related to axillary artery cannulation for acute type A aortic dissection repair

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2012.038 ◽

2012 ◽

Vol 20 (1) ◽

pp. 179-180

Author(s):

Nevzat Erdil

Keyword(s):

Aortic Dissection ◽

Axillary Artery ◽

Type A ◽

Unusual Complication ◽

Acute Type ◽

Type A Aortic Dissection ◽

Artery Cannulation

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Is right axillary artery cannulation safe in type A aortic dissection with involvement of the innominate artery?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2016.04.092 ◽

2016 ◽

Vol 152 (3) ◽

pp. 801-807.e1 ◽

Cited By ~ 17

Author(s):

Bartosz Rylski ◽

Martin Czerny ◽

Friedhelm Beyersdorf ◽

Fabian Alexander Kari ◽

Matthias Siepe ◽

...

Keyword(s):

Aortic Dissection ◽

Axillary Artery ◽

Innominate Artery ◽

Type A ◽

Type A Aortic Dissection ◽

Artery Cannulation

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

10.21203/rs.3.rs-764238/v1 ◽

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.

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