Utility of double arterial cannulation for surgical repair of acute type A dissection

Abstract

OBJECTIVES Outcomes of planned and unplanned (rescue) double arterial cannulation (DAC) in surgery for acute type A aortic dissection were investigated retrospectively. METHODS The study involved 805 patients who were divided into 4 groups according to the cannulation strategy: single cannulation of the femoral artery (n = 338), axillary artery (n = 256), left ventricular apex (n = 52) or ascending aorta (n = 5) (total, n = 57), and DAC (n = 154). Patients who underwent DAC were divided between planned (n = 132) and rescue (n = 22) usage. Characteristics and outcomes were compared between groups. Both unmatched and propensity score-matched analyses were performed. RESULTS Shock (39%, 19%, 33% and 14%, in the femoral artery, axillary artery, left ventricular apex/ascending aorta and DAC, respectively) and leg malperfusion (5%, 16%, 16% and 26%, respectively) differed significantly (P < 0.001), but in-hospital mortality did not (9%, 8%, 18% and 7%, respectively; P = 0.096). The 5-year survival rates were 79.4%, 79.7%, 78.6% and 82.2%, respectively. Propensity score-matched analysis showed no statistically significant differences in in-hospital mortality rates (10%, 12%, 14% and 9%, respectively; P = 0.78) and 5-year survival rates (78.4%, 72.3%, 82.3% and 78.0%, respectively). The leading vessel combination and indications for planned and rescue DAC were the femoral and axillary arteries (98%) and true lumen narrowing and/or leg malperfusion (34%), and the axillary followed by femoral (77%) artery and low cardiopulmonary bypass flow (36%). In-hospital mortality in the planned and rescue DAC groups was 7% and 9%, respectively. CONCLUSIONS DAC seems effective for both prevention and management of intraoperative malperfusion.

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

“…However, we didn’t find any difference on in-hospital mortality and follow-up survival between DAC and RAC group in our 431 patients’ study. Our results were similar to the study from Kusadokoro et al [ 22 ], they found that DAC had acceptable early and long-term follow-up results for both planned and unplanned (rescue) ATAAD surgery.…”

“…It arouses curiosity whether cannulation strategies differ in terms of perioperative parameters in ATAAD patients. Kusadokoro et al [ 22 ] reported that they preferred DAC in patients with true lumen stenosis and perioperative leg malperfusion. However, even with propensity score matching, the trend that DAC group were younger and with lower incidence of perioperative shock was still seen.…”

Postoperative Hepatic Dysfunction After Frozen Elephant Trunk for Type A Aortic Dissection

“…Acute dissection was referred to onset within 14 days, and emergency surgery was defined as operation performed within 24 h after hospital arrival. Retrograde perfusion was referred to performing cardiopulmonary bypass (CPB) with cannulation site of the femoral artery, including double arterial cannulation ( 8 ). We collated clinical data retrospectively from laboratory reports, radiological examination reports, and medical charts, follow-up data were obtained by telephone interview or clinic visits.…”

Cannulation strategies in type A aortic dissection: a novel insight narrative review

“…Clinical studies have confirmed that DAC can provide satisfactory cerebral and distal organ protection and avoid deep hypothermia-related side effects (56,57). The greatest advantage of DAC is that the RAAC can make up for the femoral artery-induced false cavity perfusion and that FAC can compensate for the insufficient flow of the RAAC.…”

“…This is because it can reduce postoperative complications associated with poor perfusion. Thus, DAC is effective for both the prevention and management of intraoperative malperfusion (56). In order to better understand, we had made some summaries in Table 1.…”