Direct Cannulation of Ascending Aorta versus Standard Femoral Artery Cannulation in Acute Aortic Dissection Type A

Gegouskov, Vassil; Manchev, Georgi; Danov, V.; Stoitsev, Georgi; Iliev, Sergey

doi:10.1532/hsf.1956

Cited by 7 publications

(12 citation statements)

References 27 publications

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“…Despite its increasing popularity, antegrade cannulation is also associated with potential issues. Although axillary cannulation has become more common recently, it is considered less favorable because of access challenges and the risk of injury to the brachial plexus [6,9]. Moreover, malperfusion may be a risk in cases where the blood vessels are small [2].…”

Section: Discussionmentioning

confidence: 99%

“…Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions accompanied by severe pain; they typically result in death if left untreated [1][2][3][4][5][6][7]. Over time, the risk of rupture increases.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have discussed cannulation methods extensively. In the past, femoral artery cannulation was performed as a standard practice [1, 2,4,6,9]. Over time, antegrade perfusion has become preferred to retrograde perfusion via the femoral artery [2,6,10].…”

Section: Introductionmentioning

confidence: 99%

“…In the past, femoral artery cannulation was performed as a standard practice [1, 2,4,6,9]. Over time, antegrade perfusion has become preferred to retrograde perfusion via the femoral artery [2,6,10]. Antegrade cannulation includes axillary, innominate artery, aortic, and transapical cannulations.…”

Section: Introductionmentioning

confidence: 99%

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Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study

Yoon,

Lee,

Jang

et al. 2024

J Chest Surg

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Background: Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions. Emergency surgery is typically performed under cardiopulmonary bypass immediately after diagnosis, which involves lowering the body temperature to induce total circulatory arrest. Selection of the arterial cannulation site is a critical consideration in cardiac surgery and becomes more challenging in patients with AD. This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs). Methods: This retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center. Results: Among the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p<0.001). The mean length of stay in the intensive care unit was significantly longer in the retrograde group (5±16 days) than in the antegrade group (3±5 days, p=0.013). Nevertheless, no significant difference was found between the groups in the 30-day mortality or postoperative CVA rates (p=0.2 and p=0.7, respectively). Conclusion: Surgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study

Yoon,

Lee,

Jang

et al. 2024

J Chest Surg

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show abstract

“…As a result, even if the lesion was found to be complex and require special treatment, it can be changed to routine operation without affecting the perfusion of the head. [14][15][16] Second, when aortic root and proximal anastomosis were performed, it was necessary to shift the branch vessels as close to the proximal segment as possible to ensure that the distal artificial blood vessels had enough area for anchor and support. After being strengthened by the sandwich method, the distal aortic anastomosis was anastomosed with the artificial blood vessel.…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy of Hybrid Surgery for Stanford Type A Aortic Dissection

Gu¹,

Chen²

2021

RMHP

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Introduction: To evaluate the clinical efficacy of hybrid surgery for Stanford type A aortic dissection. Methods: Twenty-two patients with Stanford type A aortic dissection were selected. All patients had completed or undergone hybrid surgery, including extracorporeal circulation, treatment of proximal anastomosis of ascending aorta and the distal anastomosis of the ascending aorta, management of the branch vessels on the arch, aortic endovascular repair. This study analyzed the time of surgery and awake, blood transfusion during surgery, patient's drainage, complications and CTA of aorta was re-examined about one month after operation during patients follow-up. Results: All patients underwent the operation successfully. One patient died of renal failure after the operation. Two patients experienced postoperative neurological complications (anxiety and delirium). Renal function was abnormal in two patients, and one patient needed bedside blood filtration. The serum creatinine levels temporarily increased in seven patients. No stent migration was found during patient follow-up. There was no shift in the stents. The near end of the interlayer was well sealed, without leakage of contrast agent, and the false lumen near the stent was completely thrombosed. Compared with the pre-operative CTA, the true lumen was enlarged and the false lumen was reduced, and the false lumen was completely thrombosed in the proximal end and near the stent. Contrast media was seen in the false lumen. Conclusion: One-stage hybrid surgery for Stanford type A aortic dissection can avoid deep hypothermic circulatory arrest, shorten operation time, reduce operation trauma, and reduce the incidence of postoperative complications. This treatment has a effective treatment effect in the short term. However, the limitations imposed by covered stent materials mean that the treatment's long-term effect is not yet clear, and further research is needed.

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Central versus peripheral cannulation for acute type A aortic dissection: A meta-analysis of over 14,000 patients

Samadzadeh Tabrizi,

Sá,

Jacquemyn

et al. 2024

The American Journal of Surgery

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Direct Cannulation of Ascending Aorta versus Standard Femoral Artery Cannulation in Acute Aortic Dissection Type A

Abstract: The direct cannulation of the ascending aorta is a safe alternative for patients with AADA, offering the opportunity for antegrade cerebral perfusion. It is easy to perform, reliable, and associated with acceptable early results.

Cited by 7 publications

References 27 publications

Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study

Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study

Clinical Efficacy of Hybrid Surgery for Stanford Type A Aortic Dissection

Central versus peripheral cannulation for acute type A aortic dissection: A meta-analysis of over 14,000 patients

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