Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience

Abstract

BackgroundRepair of acute type A aortic dissection (ATAAD) is a complex and emergent cardiovascular surgery that is associated with high perioperative morbidity and mortality. Each cannulation strategy has different benefits and drawbacks during cardiopulmonary bypass. Using a retrospective study design, we aimed to clarify the safety and efficacy of right axillary artery cannulation in combination with femoral artery cannulation compared to single arterial cannulation for ATAAD repair.MethodsFrom January 2007 to July 2017, 476 adult patients underwent ATAAD repair at a single institution. Patients were classified into groups according to their cannulation strategy: the double arterial cannulation (DAC) group (n = 377; 79.2%) or single arterial cannulation (SAC) group (n = 99; 20.8%). Preoperative demographics, surgical information, and postoperative recovery were compared between both groups. Survival and freedom from reoperation rates were analyzed using the Kaplan-Meier actuarial method.ResultsDemographics, comorbidities, and surgical procedures were generally homogenous between the two groups, except for sex, age, and rate of extensive aortic repair. Patients who underwent DAC had lower in-hospital mortality (13.5% vs. 25.3%; P = 0.005) and lower incidence of malperfusion-related complications (18.8% vs. 30.3%; P = 0.011) than those who underwent SAC. During multivariate analysis, SAC was identified as an in-hospital mortality predictor (odds ratio, 2.81; 95% confidence interval, 1.52–5.17; P = 0.001), as were preoperative ventilator support, intraoperative extracorporeal membrane oxygenation installation, and postoperative malperfusion-related complications. Three-year cumulative survival and freedom from reoperation rates were 74.8% and 85.3% for the DAC group and 62.6% and 81.1% for the SAC group, respectively (P = 0.010 and 0.430, respectively).ConclusionsWith acceptable short- and mid-term outcomes, DAC is effective and safe for establishing cardiopulmonary bypass during ATAAD repair.

Surgical rescues for critical hemopericardium complicated by acute type A aortic dissection: Emergent subxiphoid pericardiotomy or cardiopulmonary bypass first?

“…According to previous studies [14,15], hospital mortality ranges from 43% to 54% and postoperative cerebrovascular complication rates are up to 33% in this high-risk subgroup. In the present study, we observed an inferior but acceptable outcome compared to that of our previous studies among the general ATAAD population [6,7]. High incidence of preoperative CPR and shock status may be important factors attributable for the poor outcomes.…”

“…Therefore, surgeons may try to minimize the prolonged CPB time if possible. In the institution, a double arterial cannulation with ACP strategy was commonly used in ATAAD patients with relatively stable hemodynamics [7]. However, this modality can not be a routine choice for managing this critical scenario in the present study.…”

“…The aortic repair procedures are detailed in previous studies reported from this institute [6,7]. For patients with stable hemodynamics under medical treatment, the right axillary artery and/ or femoral artery were exposed and cannulated with an 8-mm ring-reinforced polytetrafluoroethylene graft.…”

Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome

“…The general principles of ATAAD repair procedures have been detailed in previous studies reported by our institution [ 12 , 13 ]. For patients who presented with an unstable hemodynamic status before surgery, especially those who required CPR, the femoral artery was considered a preferable choice for cannulation access to minimize the time required to establish cardiopulmonary bypass (CPB).…”

Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

“…The general principles of aortic repair procedures are detailed in previous studies reported by this institute 10 , 11 . For uncomplicated ATAAD patients who were considered relatively stable, double arterial cannulation with antegrade cerebral perfusion (ACP) strategy was usually implemented.…”