Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2018 May;155(5):1953-1960.e4. doi: 10.1016/j.jtcvs.2017.11.095. Epub 2017 Dec 19.
The preferred arterial cannulation site for elective proximal aortic procedures requiring circulatory arrest varies, and different sites have been tried. We evaluated the relationships between arterial cannulation site and adverse outcomes, including stroke, in patients undergoing elective aortic arch surgery.
We reviewed the records of 938 patients who underwent elective hemiarch or total arch surgery with circulatory arrest between 2006 and 2016. Five cannulation sites were used: the right axillary (n = 515; 54.9%), innominate (n = 376; 40.1%), and right common carotid arteries (n = 15; 1.6%), each with a side graft; the ascending aorta (n = 19; 2.0%); and the femoral artery (n = 13; 1.4%). Multivariable logistic regression analysis was used to model the effects of cannulation site on adverse outcomes for the entire cohort and for a subcohort of 891 patients who underwent innominate or axillary artery cannulation. Propensity-matching yielded 564 patients (282 pairs) from the right axillary and innominate artery groups.
For the entire cohort, mortality, stroke, and composite adverse outcome (operative death or persistent stroke or renal failure at hospital discharge) rates were 7.0%, 4.1%, and 9.8%. In the multivariable analysis of the axillary/innominate subcohort, cannulation site did not independently predict operative mortality, persistent stroke, or composite adverse event. These results were confirmed with the propensity-matched analysis, where both axillary and innominate artery cannulation provided equivalent composite adverse event rates, operative death rates, and overall stroke rates.
During elective arch surgery, right axillary artery cannulation and innominate artery cannulation (both via a side graft) produce excellent results and can be used interchangeably.
需要体外循环停止的择期升主动脉手术的首选动脉插管部位不同，不同部位的尝试也不同。我们评估了在接受择期主动脉弓手术的患者中，动脉插管部位与包括中风在内的不良结果之间的关系。
我们回顾了 2006 年至 2016 年间接受择期半弓或全弓手术并伴有体外循环停止的 938 例患者的记录。使用了 5 个插管部位：右腋动脉（n=515；54.9%）、无名动脉（n=376；40.1%）和右颈总动脉（n=15；1.6%），每个部位都有一个侧支移植物；升主动脉（n=19；2.0%）和股动脉（n=13；1.4%）。多变量逻辑回归分析用于模拟整个队列以及 891 例接受无名动脉或腋动脉插管的亚队列中插管部位对不良结果的影响。倾向匹配从右腋动脉和无名动脉组中获得了 564 例患者（282 对）。
对于整个队列，死亡率、中风和复合不良结局（手术死亡或出院时持续中风或肾功能衰竭）的发生率分别为 7.0%、4.1%和 9.8%。在腋动脉/无名动脉亚队列的多变量分析中，插管部位并不能独立预测手术死亡率、持续性中风或复合不良事件。这些结果在倾向匹配分析中得到了证实，腋动脉和无名动脉插管在复合不良事件发生率、手术死亡率和总中风率方面均具有等效结果。
在择期主动脉弓手术中，右腋动脉插管和无名动脉插管（均通过侧支移植物）可产生优异的结果，并且可以互换使用。
