Validity of direct bilateral axillary arterial cannulation in emergency surgery for acute type A aortic dissection

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ryo Suzuki MD, PhD, Hiroshi Kurazumi MD, PhD, Ryosuke Nawata MD, Toshiki Yokoyama MD, Kazumasa Matsunaga MD, Sarii Tsubone MD, Yutaro Matsuno MD, Kimitaka Tomisada BS, Bungo Shirasawa MD, PhD, Akihito Mikamo MD, PhD, Kimikazu Hamano MD, PhD
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引用次数: 1

Abstract

Background and Aim of the Study

To assess the validity and long-term outcomes of direct bilateral axillary arterial cannulation for acute type A aortic dissection.

Methods

Between 2003 and 2020, 208 consecutive patients with acute type A aortic dissection underwent emergency surgical repair. Cardiopulmonary bypass was attempted to establish direct bilateral axillary arterial cannulation and bicaval drainage. Antegrade selective cerebral perfusion was established by axillary perfusion and direct cannulation of the left common carotid artery.

Results

Ascending aortic, partial arch, and extended total aortic arch replacement were performed in 50 (24.0%), 7 (3.4%), and 151 (72.6%) patients, respectively. Aortic root surgery and coronary artery bypass grafting were performed concomitantly in 23 and seven patients, respectively. Cardiopulmonary bypass was attempted only through bilateral axillary cannulation in all patients but was successful in 13 (6.3%) patients without bilateral axillary cannulation. No postoperative complications occurred related to this technique. There were seven hospital deaths (early mortality rate, 3.4%). Five patients had postoperative reoperation for bleeding, and nine (4.3%) were transferred to other hospitals due to postoperative permanent cerebral infarction, particularly two with arm ischemia. The 10-year survival rate of patients who underwent emergency surgical repair with this technique was 71.4%.

Conclusions

Direct bilateral axillary arterial cannulation followed by selective cerebral perfusion was successful in 93.7% of patients and this may be an optimal solution for providing stable outcomes after emergency surgery for acute type A aortic dissection. However, we experienced two complications of arm ischemia, attention should be paid to potential arm ischemia.

双侧腋动脉直接插管在急性A型主动脉夹层急诊手术中的有效性
研究背景与目的评价双侧腋动脉直接插管治疗急性A型主动脉夹层的有效性和远期疗效。方法2003 ~ 2020年,对208例急性A型主动脉夹层患者行急诊手术修复。尝试体外循环建立双侧腋窝动脉直接插管及双腔引流。通过腋窝灌注和左颈总动脉直接插管建立顺行选择性脑灌注。结果分别有50例(24.0%)、7例(3.4%)和151例(72.6%)患者行升主动脉弓、部分主动脉弓和扩展全主动脉弓置换术。同时行主动脉根部手术和冠状动脉搭桥术分别23例和7例。所有患者仅通过双侧腋窝插管尝试体外循环,但未双侧腋窝插管的患者中有13例(6.3%)成功。无术后并发症发生。医院死亡7例(早期死亡率3.4%)。5例患者术后因出血再次手术,9例(4.3%)因术后永久性脑梗死转院,特别是2例手臂缺血。采用该技术进行紧急手术修复的患者10年生存率为71.4%。结论直接双侧腋窝动脉插管后选择性脑灌注的成功率为93.7%,这可能是急性A型主动脉夹层急诊手术后稳定预后的最佳方案。然而,我们经历了手臂缺血的两种并发症,应注意潜在的手臂缺血。
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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