Tae-Hong Yoon, Han Sol Lee, J. Jang, J. Cho, Chul Ho Lee
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This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs).\n\n\nMethods\nThis retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center.\n\n\nResults\nAmong the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p<0.001). The mean length of stay in the intensive care unit was significantly longer in the retrograde group (5±16 days) than in the antegrade group (3±5 days, p=0.013). Nevertheless, no significant difference was found between the groups in the 30-day mortality or postoperative CVA rates (p=0.2 and p=0.7, respectively).\n\n\nConclusion\nSurgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.","PeriodicalId":34499,"journal":{"name":"Journal of Chest Surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study.\",\"authors\":\"Tae-Hong Yoon, Han Sol Lee, J. Jang, J. Cho, Chul Ho Lee\",\"doi\":\"10.5090/jcs.23.156\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background\\nType A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions. Emergency surgery is typically performed under cardiopulmonary bypass immediately after diagnosis, which involves lowering the body temperature to induce total circulatory arrest. Selection of the arterial cannulation site is a critical consideration in cardiac surgery and becomes more challenging in patients with AD. This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs).\\n\\n\\nMethods\\nThis retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center.\\n\\n\\nResults\\nAmong the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p<0.001). The mean length of stay in the intensive care unit was significantly longer in the retrograde group (5±16 days) than in the antegrade group (3±5 days, p=0.013). Nevertheless, no significant difference was found between the groups in the 30-day mortality or postoperative CVA rates (p=0.2 and p=0.7, respectively).\\n\\n\\nConclusion\\nSurgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.\",\"PeriodicalId\":34499,\"journal\":{\"name\":\"Journal of Chest Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-04-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Chest Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5090/jcs.23.156\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Chest Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5090/jcs.23.156","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
背景A型主动脉夹层(AD)和壁内血肿(IMH)是病情危重的内科疾病。急诊手术通常在确诊后立即在心肺旁路下进行,包括降低体温以诱导循环完全停止。动脉插管部位的选择是心脏手术中的关键考虑因素,对于 AD 患者来说更具挑战性。本研究通过比较每种插管策略,探讨了不同插管方法的优缺点,并分析了患者预后的原因,尤其是死亡率和脑血管意外(CVA)。方法这项回顾性研究回顾了2008年至2023年期间在一个中心使用中度低体温循环停止法接受A型AD或IMH手术的患者的病历。手术结果分析表明,手术总时间有显著差异,逆行插管为 356 分钟,逆行插管为 443 分钟(P<0.001)。逆行组在重症监护室的平均住院时间(5±16 天)明显长于顺行组(3±5 天,P=0.013)。结论外科医生应该为每位患者考虑合适的插管策略,而不是严格遵守 AD 手术的特定方法。
Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study.
Background
Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions. Emergency surgery is typically performed under cardiopulmonary bypass immediately after diagnosis, which involves lowering the body temperature to induce total circulatory arrest. Selection of the arterial cannulation site is a critical consideration in cardiac surgery and becomes more challenging in patients with AD. This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs).
Methods
This retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center.
Results
Among the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p<0.001). The mean length of stay in the intensive care unit was significantly longer in the retrograde group (5±16 days) than in the antegrade group (3±5 days, p=0.013). Nevertheless, no significant difference was found between the groups in the 30-day mortality or postoperative CVA rates (p=0.2 and p=0.7, respectively).
Conclusion
Surgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.