Jeffrey G Gaca, Brittany A Zwischenberger, Keith Carr, Andrew Wang, Donald D Glower
{"title":"腋动脉插管与股动脉或中央动脉插管在小开胸二尖瓣手术中的早期结果有差异吗？","authors":"Jeffrey G Gaca, Brittany A Zwischenberger, Keith Carr, Andrew Wang, Donald D Glower","doi":"10.1177/15569845251315728","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Axillary artery cannulation techniques continue to improve and find application throughout cardiac surgery. Yet, early outcomes are poorly documented versus femoral or central arterial cannulation in right minithoracotomy mitral surgery.</p><p><strong>Methods: </strong>There were 3,044 consecutive adult patients undergoing mitral valve surgery via right thoracotomy from 1996 to 2022 examined from a prospectively maintained database. Propensity score matching was used to compare outcomes of axillary versus aortic cannulation in 241 matched pairs and axillary versus femoral cannulation in 356 matched pairs.</p><p><strong>Results: </strong>Arterial cannulation was axillary (770 of 3,044; 25%) versus femoral (149 of 3,044; 5%) or central aortic (2,125 of 3,044; 70%). Axillary versus aortic or femoral patients were older (<i>P</i> < 0.001), more often redo (<i>P</i> < 0.001), more urgent (<i>P</i> < 0.001), and had more mitral replacement (<i>P</i> < 0.001) and tricuspid procedures (<i>P</i> < 0.001). After propensity score matching, cannulation groups did not differ in patient characteristics or concurrent surgical procedures. For matched patients, axillary artery cannulation was not independently associated with operative mortality (<i>P</i> = 0.3), postoperative respiratory failure (<i>P</i> = 0.3), perioperative stroke (<i>P</i> = 0.7), renal insufficiency (<i>P</i> = 0.4), pump time (<i>P</i> = 0.6), clamp time (<i>P</i> = 0.2), transfusion (<i>P</i> = 0.5), perioperative length of stay (<i>P</i> = 0.7), or survival (<i>P</i> = 0.6). Axillary cannulation increased operative time by 14 ± 7 min (<i>P</i> = 0.04) versus aortic or femoral artery cannulation.</p><p><strong>Conclusions: </strong>Right axillary artery cannulation is a safe alternative for right minithoracotomy mitral surgery. Advantages may include avoidance of the aorta in reoperations or older patients, avoidance of peripheral atherosclerosis in older patients, and a low incidence of limb ischemia or wound infection. Disadvantages may include longer access time and an additional chest incision.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"80-86"},"PeriodicalIF":1.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Axillary Artery Versus Femoral or Central Arterial Cannulation in Minithoracotomy Mitral Surgery: Is There a Difference in Early Outcomes?\",\"authors\":\"Jeffrey G Gaca, Brittany A Zwischenberger, Keith Carr, Andrew Wang, Donald D Glower\",\"doi\":\"10.1177/15569845251315728\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Axillary artery cannulation techniques continue to improve and find application throughout cardiac surgery. Yet, early outcomes are poorly documented versus femoral or central arterial cannulation in right minithoracotomy mitral surgery.</p><p><strong>Methods: </strong>There were 3,044 consecutive adult patients undergoing mitral valve surgery via right thoracotomy from 1996 to 2022 examined from a prospectively maintained database. Propensity score matching was used to compare outcomes of axillary versus aortic cannulation in 241 matched pairs and axillary versus femoral cannulation in 356 matched pairs.</p><p><strong>Results: </strong>Arterial cannulation was axillary (770 of 3,044; 25%) versus femoral (149 of 3,044; 5%) or central aortic (2,125 of 3,044; 70%). Axillary versus aortic or femoral patients were older (<i>P</i> < 0.001), more often redo (<i>P</i> < 0.001), more urgent (<i>P</i> < 0.001), and had more mitral replacement (<i>P</i> < 0.001) and tricuspid procedures (<i>P</i> < 0.001). After propensity score matching, cannulation groups did not differ in patient characteristics or concurrent surgical procedures. For matched patients, axillary artery cannulation was not independently associated with operative mortality (<i>P</i> = 0.3), postoperative respiratory failure (<i>P</i> = 0.3), perioperative stroke (<i>P</i> = 0.7), renal insufficiency (<i>P</i> = 0.4), pump time (<i>P</i> = 0.6), clamp time (<i>P</i> = 0.2), transfusion (<i>P</i> = 0.5), perioperative length of stay (<i>P</i> = 0.7), or survival (<i>P</i> = 0.6). Axillary cannulation increased operative time by 14 ± 7 min (<i>P</i> = 0.04) versus aortic or femoral artery cannulation.</p><p><strong>Conclusions: </strong>Right axillary artery cannulation is a safe alternative for right minithoracotomy mitral surgery. Advantages may include avoidance of the aorta in reoperations or older patients, avoidance of peripheral atherosclerosis in older patients, and a low incidence of limb ischemia or wound infection. Disadvantages may include longer access time and an additional chest incision.</p>\",\"PeriodicalId\":13574,\"journal\":{\"name\":\"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery\",\"volume\":\" \",\"pages\":\"80-86\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/15569845251315728\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/14 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15569845251315728","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/14 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Axillary Artery Versus Femoral or Central Arterial Cannulation in Minithoracotomy Mitral Surgery: Is There a Difference in Early Outcomes?
Objective: Axillary artery cannulation techniques continue to improve and find application throughout cardiac surgery. Yet, early outcomes are poorly documented versus femoral or central arterial cannulation in right minithoracotomy mitral surgery.
Methods: There were 3,044 consecutive adult patients undergoing mitral valve surgery via right thoracotomy from 1996 to 2022 examined from a prospectively maintained database. Propensity score matching was used to compare outcomes of axillary versus aortic cannulation in 241 matched pairs and axillary versus femoral cannulation in 356 matched pairs.
Results: Arterial cannulation was axillary (770 of 3,044; 25%) versus femoral (149 of 3,044; 5%) or central aortic (2,125 of 3,044; 70%). Axillary versus aortic or femoral patients were older (P < 0.001), more often redo (P < 0.001), more urgent (P < 0.001), and had more mitral replacement (P < 0.001) and tricuspid procedures (P < 0.001). After propensity score matching, cannulation groups did not differ in patient characteristics or concurrent surgical procedures. For matched patients, axillary artery cannulation was not independently associated with operative mortality (P = 0.3), postoperative respiratory failure (P = 0.3), perioperative stroke (P = 0.7), renal insufficiency (P = 0.4), pump time (P = 0.6), clamp time (P = 0.2), transfusion (P = 0.5), perioperative length of stay (P = 0.7), or survival (P = 0.6). Axillary cannulation increased operative time by 14 ± 7 min (P = 0.04) versus aortic or femoral artery cannulation.
Conclusions: Right axillary artery cannulation is a safe alternative for right minithoracotomy mitral surgery. Advantages may include avoidance of the aorta in reoperations or older patients, avoidance of peripheral atherosclerosis in older patients, and a low incidence of limb ischemia or wound infection. Disadvantages may include longer access time and an additional chest incision.
期刊介绍：
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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