Tiwari Kaushal K, Murzi Michele, Bevilacqua Stefano, Glauber Mattia
Sant' Anna School for Higher Studies, Pisa, Italy.
Interact Cardiovasc Thorac Surg. 2010 May;10(5):797-802. doi: 10.1510/icvts.2009.230409. Epub 2010 Feb 13.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Which cannulation (ascending aortic cannulation or peripheral arterial cannulation) is better for acute type A aortic dissection surgery?' Altogether 393 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Femoral artery cannulation has the highest rate of mortality, stroke rate and other complications including retrograde cerebral embolization, organ malperfusion and perfusion of the false lumen. Five out of 14 papers were found to be reporting in favour of axillary (or subclavian) artery cannulation over femoral artery cannulation. In a total of 1829 patients evaluated in these studies, 1068 patients demonstrated a significantly lower complication rate with axillary artery cannulation than femoral artery cannulation. Some of the larger studies showed femoral artery cannulation has higher mortality and stroke rates ranging from 6.5% to 40% and 3% to 17%, respectively. Meanwhile, mortality and stroke rates were ranging from 3% to 8.6% and 1.75% to 4%, respectively, in the favour of axillary artery cannulation. A total of seven studies evaluated direct aortic cannulation for the establishment of cardiopulmonary bypass (CPB). They demonstrated mortality and stroke rates from 0% to 15% and 3.8% to 21%, respectively. Central cannulation has promising results with a lower mortality rate but a higher stroke rate. Direct cannulation of the true lumen is a promising method for quick and easy establishment of CPB. Axillary artery cannulation with a side graft, although it takes more time to construct, is proven to be safe and straightforward, with fewer local and systemic complications including lower mortality and neurological complications.
一篇心脏外科的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是“哪种插管方式（升主动脉插管或外周动脉插管）更适合急性A型主动脉夹层手术？”通过报告的检索共找到393篇论文，其中14篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、出版日期和国家、研究的患者群体、研究类型、相关结局及结果均列于表格中。股动脉插管的死亡率、卒中率及其他并发症发生率最高，包括逆行性脑栓塞、器官灌注不良及假腔灌注。在14篇论文中，有5篇报告支持腋（或锁骨下）动脉插管优于股动脉插管。在这些研究中总共评估的1829例患者中，1068例患者显示腋动脉插管的并发症发生率明显低于股动脉插管。一些较大规模的研究表明，股动脉插管的死亡率和卒中率较高，分别为6.5%至40%和3%至17%。同时，支持腋动脉插管的死亡率和卒中率分别为3%至8.6%和1.75%至4%。共有7项研究评估了用于建立体外循环（CPB）的直接主动脉插管。它们显示的死亡率和卒中率分别为0%至15%和3.8%至21%。中心插管有较好的结果，死亡率较低但卒中率较高。直接插管至真腔是快速简便建立CPB的一种有前景的方法。带侧支移植物的腋动脉插管，虽然构建时间较长，但被证明是安全且直接的，局部和全身并发症较少，包括较低的死亡率和神经并发症。
