Double arterial cannulation versus right axillary artery cannulation for acute type A aortic dissection: a retrospective study

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.

A comparison of single and double arterial cannulation for cardiopulmonary bypass for acute type A aortic surgery: A single center, retrospective observational study

“…In terms of postoperative liver and renal function, we compared ALT and creatinine levels at 1 and 3 days after surgery, respectively. Zhang et al 14 reported DAC reduced the incidence of postoperative renal injury compared to AAC, suggesting it might be benefit for renal protection. However, postoperative creatinine levels were similar in two groups in our study, indicating DAC was similar to AAC in protecting renal function.…”

“…27 Moreover, it may enhance renal perfusion and reduce the risk of renal impairment following surgery in comparison with other cannulations. 14,22 However, the inherent disadvantages include retrograde brain flow, the risk of malperfusion, and possible damage to the artery, which is located far from the lower extremity of the vasculature. The brain perfusion suggested DAC provided better brain protection.…”

“…12 In recent years, some surgeons have introduced double arterial cannulation via axillary and femoral artery (DAC) in TAAD procedure, but studies about the comparisons between DAC and AAC are still limited. 3,13,14 The hypothesis for this study is single axillary or subclavian artery cannulation is an effective and safe alternative technique to double cannulation of the axillary and femoral arteries. Therefore, our aim is to compare postoperative outcomes and mortality between patients who underwent DAC and AAC based on a retrospective analysis of single center's experiences.…”

The relationship between false-lumen area ratio and renal replacement therapy after acute aortic dissection repair on bilateral artery cannulation: a cross-sectional study

“…Some known advantages of double artery cannulation include stabilization of CPB flow, avoidance of the overuse of large cannulas on the axillary artery, prevention of the retrograde perfusion that occurs with single femoral artery cannulation, and a shorter cooling period ( 17 ). The application of bilateral artery perfusion has been shown not to increase the surgical risks compared to RAA cannulation but could help reduce the incidence of postoperative AKI ( 18 ). In this situation, femoral cannulation can increase visceral perfusion and compensate for the partial blood to the celiac and superior mesenteric arteries, as the intimal flap motion block in the AAD model is perfused only by axillary cannulation ( 19 ).…”

Cannulation Strategies in Type A Aortic Dissection: Overlooked Details and Novel Approaches

“…Each method has distinct effects on patient survival, cerebral perfusion, and malperfusion hazards [11,24]. The significance of individualized decision-making in AAD surgery is highlighted by the fact that the choice depends on anatomical considerations, surgeon expertise, and patient factors.…”