Central versus peripheral arterial cannulation and neurological outcomes after thoracic aortic surgery: meta-analysis and meta-regression of 4459 patients

Chalegre, Sintya Tertuliano; Rueda, Fábio Gonçalves de; Salerno, Pedro Rafael; Vasconcelos, Frederico Pires; Lima, Ricardo Carvalho

doi:10.1177/0267659114547379

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…Although most indicators of liver and renal function were comparable between the two cannulation groups, a few (AST, BUN level and AST/ALT, BUN/Cr ratio) were significantly higher for peripheral than for central cannulation. This finding likely suggests the presence of inadequate organ perfusion and is consistent with changes observed in humans undergoing peripheral cannulation ( 30 ). For peripheral cannulation, the susceptibility to unstable flow after establishing extracorporeal circulation and the need to frequently adjust pipeline position (to maintain the rate of blood flow) could result in insufficient organ perfusion.…”

Section: Discussionsupporting

confidence: 83%

“…However, central cannulation requires median sternotomy, which is more invasive and can cause excessive bleeding. Some reports point out that patients undergoing central cannulation have significantly higher rates of infection, blood product usage and reoperation compared with those undergoing peripheral cannulation ( 30 , 31 ). In addition, peripheral cannulation is less invasive and can be used in many different clinical scenarios, facilitating, for example, convenient transfer of extracorporeal equipment.…”

Section: Discussionmentioning

confidence: 99%

“…The fetal sheep was examined by echocardiogram at the beginning (T0),30 min (T1), and 60 min (T2) after initiation of CPB. Several echocardiographic parameters were collected, including left ventricular isovolumic contraction time (LV-IVCT), left ventricular isovolumic relaxation time (LV-IVRT), right ventricular isovolumic contraction time (RV-IVCT), right ventricular isovolumic relaxation time (RV-IVRT), aortic valve diameter (AVD), left ventricular outflow tract velocity time integral (LVOT-VTI), pulmonary valve diameter (PVD), right ventricular outflow tract velocity time integral (RVOT-VTI), umbilical artery pulsation index (Umbilical artery-PI), and umbilical artery resistance index (Umbilical artery-RI).…”

mentioning

confidence: 99%

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Central and Peripheral Cannulation for Cardiopulmonary Bypass in Fetal Sheep: A Comparative Study

Teng

Tian

Jiang

et al. 2021

Front. Cardiovasc. Med.

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Objective:In-utero correction is an option for treatment of critical congenital heart diseases (CHDs). Fetal cardiac surgery for CHDs is dependent on the reliable use of fetal cardiopulmonary bypass (CPB), but this technology remains experimental. In this study, we established fetal CPB models with central and peripheral cannulation to explore the differences between the two cannulation strategies.Methods: Ten fetal sheep with 90–110 gestational days were randomized into central cannulation (n = 5) and peripheral cannulation (n = 5) groups. All fetal CPB models were successfully established. At each time point (0, 30, and 60 min after initiation of CPB), echocardiography was performed. Blood samples were also collected for blood gas analysis and tests of myocardial enzymes and liver and kidney function.Results: In the central cannulation group, right ventricular Tei index significantly increased (p = 0.016) over time. Compared with the peripheral cannulation group, the left ventricular Tei index of the central cannulation group was significantly higher (1.96 ± 0.31 vs. 0.45 ± 0.19, respectively; p = 0.028) and the stroke volume was lower (0.46 ± 0.55 vs. 2.13 ± 0.05, respectively; p = 0.008) at 60 min after CPB. Levels of liver and kidney injury markers and of acid-base balance, including alanine aminotransferase (ALT), aspartate aminotransferase/ALT ratio, blood urea nitrogen (BUN), BUN/creatinine ratio, base excess and bicarbonates, were significantly higher for peripheral than for central cannulation. Other important physiologic parameters, including heart rate, blood pressure, myocardial enzymes, umbilical artery beat index and resistance index, left ventricular Tei index, and left and right ventricular stroke volume, were comparable between the two groups.Conclusions: Both central and peripheral cannulations can be used to establish fetal CPB models. Central cannulation causes more adverse impacts for cardiac function, whereas peripheral cannulation is more susceptible to complications related to inadequate organ perfusion.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Central and Peripheral Cannulation for Cardiopulmonary Bypass in Fetal Sheep: A Comparative Study

Teng

Tian

Jiang

et al. 2021

Front. Cardiovasc. Med.

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“…11 Current reports also showed that the preferred first-choice arterial cannulation site was the axillary artery, regardless of the acuteness or aortic pathology. 12 However, a general recommendation for the use of the axillary artery cannulation during aortic arch repair has not yet been advocated because of the lack of randomized trials and the insufficient level of evidence, and because the studies on this topic have had inconsistent inclusion criteria. 13,14 To verify our hypothesis that the axillary artery cannulation might reduce the early embolic stroke and operative mortality, we retrospectively compared the outcomes between patients with or without axillary artery cannulation during open aortic arch repair with circulatory arrest.…”

Section: Central Messagementioning

confidence: 99%

Axillary artery cannulation reduces early embolic stroke and mortality after open arch repair with circulatory arrest

Kim

Lee

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objective: To evaluate the efficacy of axillary artery cannulation for early embolic stroke and operative mortality, we retrospectively compared the outcomes between patients with or without axillary artery cannulation during open aortic arch repair with circulatory arrest.Methods: Between January 2004 and December 2017, 468 patients underwent open aortic arch repair with circulatory arrest using antegrade cerebral perfusion and were divided into 2 groups according to the site of arterial cannulation: the axillary artery (axillary group, n ¼ 352) or another site (nonaxillary group, n ¼ 116) groups. Embolic stroke was defined as a physician-diagnosed new postoperative neurologic deficit lasting more than 72 hours, generally confirmed by computed tomography or magnetic resonance imaging.Results: After propensity score matching, the patients' characteristics were comparable between the groups (n ¼ 116 in each). The incidences of acute type A dissection, aortic rupture, shock, or emergency operation were similar between groups. The incidence of early embolic stroke was significantly lower in axillary group (n ¼ 3 [2.6%] vs n ¼ 10 [8.6%]; P ¼ .046). Also, 30-day mortality (n ¼ 3 [2.6%] vs n ¼ 10 [8.6%]; P ¼ .046) and in-hospital mortality (n ¼ 3 [2.6%] vs n ¼ 11 [9.5%]; P ¼ .027) occurred significantly lower in the axillary group. Conclusions: Axillary artery cannulation reduced the early embolic stroke and early mortality after open arch repair with circulatory arrest. Axillary artery cannulation as the arterial cannulation site during open arch repair with circulatory arrest may be helpful in preventing embolic stroke and reducing early mortality.

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“…10 Various cannulation strategies have been established, especially in aortic surgery, in which modification of cannulation according to the lesion to be operated on is mandatory to maintain end-organ perfusion. 2 In addition, not only cannulation but also the degree of hypothermia (mild vs moderate vs deep hypothermia) is an important component of the CPB strategy. 3,11 In terms of cannulation, in our case, central cannulation after sternotomy was impossible because of ongoing chest compression; thus, peripheral cannulation via femoral vessels was initially attempted and CPB was started via the femoral vessels.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative inadvertent piercing of the aortic arch: case report

Kim¹,

Kim²,

Kim³

et al. 2020

Journal of Neurosurgery: Spine

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Central versus peripheral arterial cannulation and neurological outcomes after thoracic aortic surgery: meta-analysis and meta-regression of 4459 patients

Abstract: When it comes to neurological outcomes in patients undergoing thoracic aortic surgery, there was no evidence that argues in favor of any choice of arterial cannulation site, which makes us reject any superiority of one approach over the other in this regard.

Cited by 5 publications

References 16 publications

Central and Peripheral Cannulation for Cardiopulmonary Bypass in Fetal Sheep: A Comparative Study

Central and Peripheral Cannulation for Cardiopulmonary Bypass in Fetal Sheep: A Comparative Study

Axillary artery cannulation reduces early embolic stroke and mortality after open arch repair with circulatory arrest

Intraoperative inadvertent piercing of the aortic arch: case report

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