Reduction of maximal false lumen area ratio by interactive cannulation perfusion in DeBakey type I acute aortic dissection repair.

Abstract

Introduction: Acknowledging lacking of recognition on postoperative aortic remodeling by intraoperative transition of cannulation perfusion mode during the open repair surgery of DeBakey type I acute aortic dissection (AAD), this study aims to investigate the effect of interactive cannulation strategy on the maximum false lumen area (MFLA) ratio.

Methods: A total of 321 AAD patients were retrospectively reviewed from March 2017 to March 2023, of which 166 patients receiving peripheral cannulation (PC, right axillary and femoral artery) and 155 patients receiving peripheral-to-centric cannulation (PCC, transition from right axillary and femoral artery to one branch of the tetrafurcated graft). The primary outcome was postoperative MFLA ratio in descending thoracic aorta. Secondary outcomes were postoperative inflammation response and anaerobic metabolism, hepatorenal dysfunction, and the ostium condition of branch artery of abdominal aorta involved by false lumen.

Results: There was a lower postoperative MFLA ratio in PCC group than that in PC group, respectively (0.36±0.11 vs. 0.44±0.13, P<0.001). The abdominal branch arteries involved by false lumen was also deceased in PCC group. There was also a lower serum inflammation response (24 hours, hr-CRP: 111.8±14.1mg/L vs. 116.8±15.0mg/L, P=0.002; IL-6: 104.4±49.9pg/ml vs. 124.0±50.1pg/ml, P<0.001), anaerobic metabolism (8 hours, lactate: 8.3±1.5mmol/L vs. 8.8±1.6mmol/L, P=0.002), impaired liver function (15.5% vs. 39.8%, P<0.001) and need for renal replacement therapy (10.3% vs. 20.5%, P=0.012) in PCC group than those in PC group.

Conclusion: Interactive cannulation with prompt transition from peripheral artery to centric perfusion during surgical repair of AAD was associated with the reduction of MFLA and hepatorenal dysfunction.