Cannulation strategies &amp; circulation management in type‐A aortic dissection

Saran, Nishant; Pochettino, Alberto

doi:10.1111/jocs.15456

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…Axillary cannulation includes side-graft and direct cannulation. For side-graft cannulation sewing an 8-10 mm graft to axillary artery, with less cannula resistance and consequently decreased risk of peripheral damage (34). During circulatory arrest for aortic arch repair, the sidegraft cannulation allowed unilateral antegrade cerebral perfusion by clamping the proximal innominate artery and indirect pressure monitoring by right radial artery catheterization.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Post-operative Outcomes Between Direct Axillary Artery Cannulation and Side-Graft Axillary Artery Cannulation in Cardiac Surgery: A Systematic Review and Meta-Analysis

Xie

Liu

Yang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThere is a growing perception of using axillary artery cannulation to improve operative outcomes in cardiopulmonary bypass surgery. Two techniques, direct cannulation or side-graft cannulation, can be used for axillary artery cannulation, but which technique is better is controversial.MethodsA meta-analysis of comparative studies reporting operative outcomes using direct cannulation vs. side-graft cannulation was performed. We searched the PubMed, EMbase, Web of Science, and Cochrane Library. Outcomes of interest were neurological dysfunction, cannulation-related complications and early mortality. The fixed effects model was used.ResultsA total of 1,543 patients were included in the final analysis. Direct cannulation was used in 846 patients, and side-graft cannulation was used in 697 patients. Meta-analysis showed a higher occurrence of neurological Complication in direct cannulation group [odds ratio, 1.45, 95% CI (1.00, 2.10), χ2 = 4.40, P = 0.05] and a significantly higher incidence of cannulation-related complications in the direct cannulation group [odds ratio, 3.12, 95% CI (1.87, 5.18), χ2 = 2.54, P < 0.0001]. The incidence of early mortality did not have a difference [odds ratio, 0.95, 95% CI (0.64, 1.41), χ2 = 6.35, P = 0.79].ConclusionsThis study suggests that side-graft axillary artery cannulation is a better strategy as it reduces the incidence of neurological dysfunction and cannulation-related complications.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022325456.

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Section: Discussionmentioning

confidence: 99%

Comparison of Post-operative Outcomes Between Direct Axillary Artery Cannulation and Side-Graft Axillary Artery Cannulation in Cardiac Surgery: A Systematic Review and Meta-Analysis

Xie

Liu

Yang

et al. 2022

Front. Cardiovasc. Med.

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“…In most cases, AAD pathology starts with intimal injury, leading to false lumen formation. Then, an intimal-medial flap separates the false lumen from the true lumen [ 7 , 8 ]. Blood malperfusion triggers the propagation of aortic dissection, resulting in the ischemia of involved organs.…”

Section: Pathophysiology and Epidemiologymentioning

confidence: 99%

“…A recent study suggested that inflammation and coagulation are involved in AAD combined ALI [ 7 , 10 ]. Endothelial and epithelial barriers are destroyed by increased alveolar-capillary barrier permeability, which is responsible for ALI [ 11 ].…”

Section: Cellular and Biochemical Regulatory Pathwaysmentioning

confidence: 99%

Acute Lung Injury in aortic dissection : new insights in anesthetic management strategies

Yang

2023

J Cardiothorac Surg

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Acute aortic dissection (AAD) is a severe cardiovascular disease characterized by rapid progress and a high mortality rate. The incidence of acute aortic dissection is approximately 5 to 30 per 1 million people worldwide. In clinical practice, about 35% of AAD patients are complicated with acute lung injury (ALI). AAD complicated with ALI can seriously affect patients’ prognosis and even increase mortality. However, the pathogenesis of AAD combined with ALI remains largely unknown. Given the public health burden of AAD combined with ALI, we reviewed the anesthetic management advances and highlighted potential areas for clinical practice.

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“…In surgical interventions for type I aortic dissection, the choice of cannulation and perfusion strategies during extracorporeal circulation is essential for ensuring surgical safety and optimizing patient outcomes [ 3 ]. Currently, there exist several perfusion strategies for surgical interventions in aortic dissection, including axillary artery cannulation for perfusion, femoral artery cannulation for perfusion, and combined femoral-axillary dual perfusion, among other techniques [ 4 , 5 ], which have significantly advanced the development of perfusion technology in surgical interventions for aortic dissection. Despite their benefits, various perfusion catheterization strategies have inherent limitations.…”

Section: Introductionmentioning

confidence: 99%

Clinical Application of Proximal Arch Cannulation in the Surgical Treatment of Acute Type I Aortic Dissection

Khan¹,

Luo²,

Fan³

et al. 2023

Cureus

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The goal is to determine the best location for inserting a catheter into the aortic arch of patients with a certain type of aortic dissection (DeBakey type I) by analyzing images of the patient's aortic arch before surgery. This analysis will take into account the shape and structure of the patient's aortic arch to find the most optimal location for cannulation. MethodsA retrospective analysis was conducted on 100 patients with acute DeBakey type I aortic dissection diagnosed between January 2021 and February 2023, utilizing the Carestream medical imaging software Image Suite V4 (New York, USA). The study included 67 cases that underwent surgery and 33 cases that did not. The study aimed to evaluate the optimal intubation position on the patient's aortic arch by analyzing the true and false lumen classification, true and false lumen area, and hematoma thickness on the patient's aortic arch, as observed in the aortic computed tomography angiography (CTA) conducted upon admission. ResultsThe vascular axis analysis showed a significant difference in the true lumen area among the three regions that were examined (P < 0.001). Zone 1 had a larger true lumen area of 6.40 ± 2.71 cm 2 compared to zone 2 with 5.75 ± 2.13 cm 2 and zone 3 with 4.85 ± 1.70 cm 2 , as determined by statistical analysis.In addition, the statistical analysis of hematoma thickness in the three regions where cannulation can be performed revealed a significant difference among the three groups (P = 0.027). Further analysis showed that there was no significant difference between zone 1 and zone 2 (P = 1.000), a significant difference between zone 1 and zone 3 (P < 0.046), and no significant difference between zone 2 and zone 3 (P = 0.080). The difference between zone 1 false lumen thickness of 1.55 ± 0.51 cm and zone 3 false lumen thickness of 1.33 ± 0.55 cm was found to be small. ConclusionCannulation of the aortic arch is a common strategy used in cardiac surgery. Accurate cannulation is critical to the success of the procedure. The use of CTA provides valuable guidance for the cannulation procedure. A thorough examination of CTA and precise measurement of relevant parameters can help guide the surgeon to determine the optimal cannulation site. The study found that zone 1 of the aortic arch has the largest area and is the most suitable for cannulation, in accordance with the physiological characteristics and surgical practices of a surgeon. Furthermore, cannulation of the aortic arch has been found to be a safe and effective strategy for cannulation. Overall, careful examination of CTA and accurate measurement of relevant parameters can have a significant guiding effect on the cannulation of the aortic arch, which can lead to improved outcomes in cardiac surgery.

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Cannulation strategies & circulation management in type‐A aortic dissection

Cited by 7 publications

References 37 publications

Comparison of Post-operative Outcomes Between Direct Axillary Artery Cannulation and Side-Graft Axillary Artery Cannulation in Cardiac Surgery: A Systematic Review and Meta-Analysis

Comparison of Post-operative Outcomes Between Direct Axillary Artery Cannulation and Side-Graft Axillary Artery Cannulation in Cardiac Surgery: A Systematic Review and Meta-Analysis

Acute Lung Injury in aortic dissection : new insights in anesthetic management strategies

Clinical Application of Proximal Arch Cannulation in the Surgical Treatment of Acute Type I Aortic Dissection

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