Rahimi-Barfeh Azizolah, Grothusen Christina, Haneya Assad, Schöttler Jan, Eide Arne M, Erdmann Maria, Friedrich Christine, Hoffmann Grischa, Cremer Jochen, Schoeneich Felix
Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Ann Thorac Surg. 2016 May;101(5):1753-8. doi: 10.1016/j.athoracsur.2015.10.043. Epub 2016 Jan 12.
Acute type A aortic dissection (AAD) is a life-threatening disorder with a high rate of mortality and complications. All cannulation techniques currently used to establish arterial flow for cardiopulmonary bypass are associated with a considerable risk of organ malperfusion, stroke, or access site trauma. Here, we report the impact of transatrial cannulation of the left ventricle on patient outcome after surgical treatment of AAD.
Between 2010 and 2013, 46 patients underwent emergency surgery for AAD using transatrial cannulation of the left ventricle. Their outcome was retrospectively compared with that of 73 age- and sex-matched patients operated on for AAD between 2006 and 2010 before introduction of the new technique.
No differences concerning preoperative details were found. Arterial flow before 2010 was established after preparation of the femoral artery in 46 patients (63.0%) or by direct cannulation of the ascending aorta in 27 patients (37.0%). Operation times were significantly lower in the transatrial cannulation group (271.2 ± 75.4 versus 308.3 ± 78.2; p = 0.02). Postoperatively, we observed a significantly reduced stroke rate in the group with transatrial cannulation (6.5% versus 26.5%; p = 0.007) and a decreased rate of acute renal failure (20.0% versus 32.4%; p = 0.003). Intraoperative mortality (0% versus 6.8%; p = 0.16), 30-day mortality (8.9% versus 10.3%; p = 1.00), and mortality during follow-up (9.8% versus 34.4%; p = 0.08) did not differ. However, overall mortality was significantly lower in the group after transatrial cannulation (17.7% versus 45.2%; p = 0.003).
In patients undergoing surgery for AAD, transatrial cannulation of the left ventricle proved to be a safe and easy cannulation method that significantly reduced postoperative complications.
急性A型主动脉夹层（AAD）是一种危及生命的疾病，死亡率和并发症发生率很高。目前用于建立体外循环动脉血流的所有插管技术都存在相当大的器官灌注不良、中风或穿刺部位创伤风险。在此，我们报告左心室经心房插管对AAD手术治疗后患者预后的影响。
2010年至2013年期间，46例患者接受了采用左心室经心房插管的AAD急诊手术。将他们的预后与2006年至2010年在新技术引入之前接受AAD手术的73例年龄和性别匹配患者的预后进行回顾性比较。
术前细节方面未发现差异。2010年之前，46例患者（63.0%）在准备股动脉后建立动脉血流，27例患者（37.0%）通过直接升主动脉插管建立动脉血流。经心房插管组的手术时间显著更短（271.2±75.4对308.3±78.2；p=0.02）。术后，我们观察到经心房插管组的中风发生率显著降低（6.5%对26.5%；p=0.007），急性肾衰竭发生率降低（20.0%对32.4%；p=0.003）。术中死亡率（0%对6.8%；p=0.16）、30天死亡率（8.9%对10.3%；p=1.00）和随访期间死亡率（9.8%对34.4%；p=0.08）无差异。然而，经心房插管组的总体死亡率显著更低（17.7%对45.2%；p=0.003）。
在接受AAD手术的患者中，左心室经心房插管被证明是一种安全、简便的插管方法，可显著降低术后并发症。
